A Multicenter Evaluation of Vancomycin-Associated Acute Kidney Injury in Hospitalized Patients with Acute Bacterial Skin and Skin Structure Infections

Infectious Diseases and Therapy

Karrine D. Brade¹  Michael P. Veve²  Kyle P. Murray³  Abdalhamid M. Lagnf⁴  Sahil Bhatia⁴  Muhammad-Daniayl Shamim⁴  Sarah C. J. Jorgensen⁴  Sarah Melvin⁴  Susan L. Davis⁴  Michael J. Rybak⁴  Jordan R. Smith⁵  Karen S. Williams⁶  Samuel P. Simon⁷  David B. Huang⁸  Jessica K. Ortwine⁹  James Truong^1,10  Jerod Nagel^1,11 

[1] Boston Medical Center;College of Pharmacy, University of Tennessee Health Sciences Center;Detroit Medical Center;Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University;Fred Wilson School of Pharmacy, High Point University;Guthrie Robert Packer Hospital;Maimonides Medical Center;Motif BioSciences;Parkland Memorial Hospital;The Brooklyn Hospital Center;University of Michigan;

关键词: Acute bacterial skin and soft tissue infection;    Acute kidney injury;    Nephrotoxicity;    Vancomycin;   

DOI  :  10.1007/s40121-019-00278-1

来源: DOAJ

【 摘 要 】

Abstract Background We sought to determine the real-world incidence of and risk factors for vancomycin-associated acute kidney injury (V-AKI) in hospitalized adults with acute bacterial skin and skin structure infections (ABSSSI). Methods Retrospective, observational, cohort study at ten U.S. medical centers between 2015 and 2019. Hospitalized patients treated with vancomycin (≥ 72 h) for ABSSSI and ≥ one baseline AKI risk factor were eligible. Patients with end-stage kidney disease, on renal replacement therapy or AKI at baseline, were excluded. The primary outcome was V-AKI by the vancomycin guidelines criteria. Results In total, 415 patients were included. V-AKI occurred in 39 (9.4%) patients. Independent risk factors for V-AKI were: chronic alcohol abuse (aOR 4.710, 95% CI 1.929–11.499), no medical insurance (aOR 3.451, 95% CI 1.310–9.090), ICU residence (aOR 4.398, 95% CI 1.676–11.541), Gram-negative coverage (aOR 2.926, 95% CI 1.158–7.392) and vancomycin duration (aOR 1.143, 95% CI 1.037–1.260). Based on infection severity and comorbidities, 34.7% of patients were candidates for oral antibiotics at baseline and 39.3% had non-purulent cellulitis which could have been more appropriately treated with a beta-lactam. Patients with V-AKI had significantly longer hospital lengths of stay (9 vs. 6 days, p = 0.001), higher 30-day readmission rates (30.8 vs. 9.0%, p < 0.001) and increased all-cause 30-day mortality (5.1 vs. 0.3%, p = 0.024) Conclusions V-AKI occurred in approximately one in ten ABSSSI patients and may be largely prevented by preferential use of oral antibiotics whenever possible, using beta-lactams for non-purulent cellulitis and limiting durations of vancomycin therapy.

【 授权许可】

Unknown