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Kidney Week

Abstract: PO0233

Reduction of Intraoperative Nephrotoxic Antimicrobial Exposure Can Decrease the Severity of Stage of AKI and Improve Renal Recovery in Patients Undergoing Heart Transplantation

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • McMahon, Blaithin A., Medical University of South Carolina, Charleston, South Carolina, United States
  • Quadri, Syed M.Z, Medical University of South Carolina, Charleston, South Carolina, United States
Background

Acute Kidney Injury (AKI) is very common complication post-heart transplant with a reported incidence of approximately 47-76%. Antibiotic combinations, such as piperacillin-tazobactam and vancomycin can cause nephrotoxicity and AKI especially in high doses.The mechanism for this nephrotoxicity is not clear.. The purpose of this study was to evaluate the impact of reducing intraoperative nephrotoxic antibiotic exposure on the rate of Acute Kidney Injury and renal recovery in adult patients undergoing heart transplantation.

Methods

This is a single-center prospective study design of all adult patients undergoing heart transplants at Medical University of South Carolina between 4/12/2015 to 5/1/2020. In 06/20/2019, as part of a quality improvement effort to reduce our AKI rate, we changed empiric intraoperative antimicrobial coverage from piperacillin-tazobactam to cefepime while continuing vancomycin use. We collected data using the electronic health record. AKI severity and recovery were extracted for patients exposed to piperacillin-tazobactam and vancomycin or cefepime and vancomycin. AKI was identified using KDIGO serum creatinine criteria. Renal recovery was defined as 25% improvement in serum creatinine within 7 days. We assessed rates of nephrotoxin exposure and KDIGO AKI rates in all heart transplant inpatients for at least 4 years pre-intervention and almost 1 year post-intervention.

Results

While the overall rate of AKI remained the same after the intervention, the rates of severe stage 3 AKI decreased by 32%. Recovery of AKI prior to hospital discharge improved 4-fold in the intervention group (24.0% vs 6.0 %, P < 0.05). There was a trend towards less readmissions at 6 months with the intervention group (48.6% vs. 65.9%; p=0.117).

Conclusion

Reduction of nephrotoxic antimicrobial exposure can decrease the severity of heart transplant-related AKI and improve AKI recovery rates.