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Kidney Week

Abstract: FR-OR027

Reduction in Nephrotoxic Antimicrobial Exposure Decreases Associated AKI in Pediatric Hematopoietic Stem Cell Transplant Patients (HSCT)

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Benoit, Stefanie W., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Dahale, Devesh S., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Haslam, David B., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Nelson, Adam, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Truono, Kori, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Davies, Stella M., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Exposure to nephrotoxic medications (NTMx) is a common risk factor for AKI. Quality improvement work in antimicrobial stewardship and NTMx-associated AKI (NAKI) reduction took place at Cincinnati Children’s Hospital from 2013 to 2018. We hypothesized that choosing less nephrotoxic antimicrobial medications for HSCT patients would be associated with lower NAKI rates and no increase in treatment failures.

Methods

We used data from a prospective NAKI monitoring system within our electronic health record. AKI days and severity were extracted for patients exposed to 3+ NTMx or 3+ days of IV aminoglycosides (AG). AKI was defined using KDIGO creatinine criteria. We assessed rates of NTMx exposure and NAKI in all HSCT inpatients from 09/2013 to 03/2018. The percent of repeat positive cultures was used to capture treatment failures. Data were grouped and analyzed by calendar month.

Results

The HSCT division changed frontline fever treatment from piperacillin-tazobactam (pip-tazo) to cefipime, and AG use was limited. Cidofovir use decreased with availability of brincidofovir and antiviral cytotoxic T-lymphocytes. There were no other major changes in supportive care practices. Rates of NTMx exposure, NAKI, and percent of repeat positive cultures all decreased, as shown in Table 1. Mean rates of all stages of NAKI decreased >50% after 01/2016, which coincided with the divisional change from pip-tazo to cefipime. Rates of NAKI have since remained stable.

Conclusion

Reduction of nephrotoxic antimicrobial exposure may decrease the amount and severity of NAKI in HSCT patients without an increase in treatment failures.

Change in Rate of NTMx Exposure, Associated AKI, and Repeat Positive Cultures.
 Period 1: 09/2013 – 01/2016
(Mean per 1000 patient days)
Period 2: 01/2016 – 03/2018
(Mean per 1000 patient days)
Nephrotoxin Exposed Patients25.4614.53
All AKI29.6512.92
Stage 1 AKI16.76.42
Stage 2 AKI9.24.14
Stage 3 AKI3.751.16
Percent Repeat Positive Blood Cultures10%7.3%