Acute kidney injury during daptomycin versus vancomycin treatment in cardiovascular critically ill patients: a propensity score matched analysis

BMC Infectious Diseases

Maxime Villiet¹  Marine Saour²  Jacob Eliet²  Pascal Colson²  David Morquin³  Philippe Gaudard⁴  Hélène David⁴  Jean-Pierre Daures⁵ 

[1] 0000 0000 9961 060X, grid.157868.5, Clinical Pharmacy Department, CHU Montpellier, Montpellier, France;0000 0000 9961 060X, grid.157868.5, Department of cardiothoracic Anaesthesiology and Critical Care Medicine, CHU Montpellier, Montpellier, France;0000 0000 9961 060X, grid.157868.5, Infectious and Tropical Diseases Department, CHU Montpellier, Montpellier, France;0000 0000 9961 060X, grid.157868.5, PhyMedExp, University of Montpellier, CNRS, INSERM, Department of cardiothoracic Anaesthesiology and Critical Care Medicine, CHU Montpellier, Montpellier, France;Laboratory of Biostatistics and Epidemiology EA2415, University Institute for Clinical Research, Montpellier, France;

关键词: Vancomycin;    Daptomycin;    Acute kidney injury;    Nephrotoxicity;    Infective endocarditis;    Foreign body associated infection;    Cardiovascular surgery;   

DOI  :  10.1186/s12879-019-4077-1

来源: publisher

【 摘 要 】

BackgroundGram-positive organisms are a leading cause of infection in cardiovascular surgery. Furthermore, these patients have a high risk of developing postoperative renal failure in intensive care unit (ICU). Some antibiotic drugs are known to impair renal function. The aim of the study was to evaluate whether patients treated for Gram-positive cardiovascular infection with daptomycin (DAP) experienced a lower incidence of acute kidney injury (AKI) when compared to patients treated with vancomycin (VAN), with comparable efficacy.MethodsICU patients who received either DAP or VAN, prior to or after cardiovascular surgery or mechanical circulatory support, from January 2010 to December 2012, were included in this observational retrospective cohort study. We excluded patients with end stage renal disease and antibiotic prophylaxis. The primary endpoint was the incidence of AKI within the first week of treatment. Secondary endpoints were the incidence of AKI within the first 14 days of treatment, the severity of AKI including renal replacement therapy (RRT), the rates of clinical failure (unsuccessful infection treatment) and of premature discontinuation and mortality. To minimize selection bias, we used a propensity score to compare the 2 groups. Univariate and multivariate analysis were performed to determine factors associated with AKI.ResultsSeventy two patients, treated for infective endocarditis, cardiovascular foreign body infection, or surgical site infection were included (DAP, n = 28 and VAN, n = 44). AKI at day 7 was observed in 28 (64%) versus 6 (21%) of the VAN and DAP patients, respectively (p = 0.001). In the multivariate analysis adjusted to the propensity score, vancomycin treatment was the only factor associated with AKI (Odds Ratio 4.42; 95% CI: 1.39–15.34; p = 0.014). RRT was required for 2 (7%) DAP patients and 13 (30%) VAN patients, p = 0.035. Premature discontinuation and clinical failure occurred more frequently in VAN group than in DAP group (25% versus 4%, p = 0.022 and 42% versus 12%, respectively, p = 0.027).ConclusionsDaptomycin appears to be safer than vancomycin in terms of AKI risk in ICU patients treated for cardiovascular procedure-related infection. Daptomycin could be considered as a first line treatment to prevent AKI in high-risk patients.

【 授权许可】

CC BY