126. Acute Kidney Injury During Therapy with Vancomycin in Combination with Beta-Lactams
Session: Poster Abstract Session: Antimicrobial Stewardship: Adverse Drug Events
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • ID Week Poster - Jessica Cox PharmD.pdf (177.1 kB)
  • Background: Recent reports have demonstrated that vancomycin (VAN) may lead to an increase in acute kidney injury (AKI) when combined with beta-lactams. These agents remain the mainstay of treatment for methicillin-resistant Staphylococcus and serious gram-negative infections, respectively, at our institution. The objective of this study was to compare the incidence of AKI associated with vancomycin plus piperacillin-tazobactam (TZP) or cefepime (FEP).

    Methods: We evaluated all adult patients who received VAN in combination with either TZP or FEP for at least 48 hours at our institution between September 2010 and September 2014. Patients were excluded for: severe chronic or structural kidney disease, dialysis, pregnancy, cystic fibrosis, receipt of radiologic contrast or were transferred from another hospital. All data (e.g., demographics, antibiotic regimens, Charlson Comorbidity Index, laboratory results, vital signs, etc.) were obtained from the University of Kentucky Enterprise Data Trust. AKI was evaluated using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) criteria. Patients in the VAN+TZP group were matched in a three-to-one manner to patients in the VAN+FEP group based on seven parameters: age, sex, Charlson Comorbidity Index, baseline creatinine clearance, hypotension, number of nephrotoxicity risk factors, and median days of combination therapy.

    Results: A total of 2592 patients were evaluated in our matched analysis with 1944 patients receiving VAN+TZP and 648 patients receiving VAN+FEP. The incidence of any AKI was significantly higher in patients receiving VAN+TZP compared to patients receiving VAN+FEP (30% vs 18%, p<0.0001), resulting in an average treatment effect of -12.0% (95% CI; -14.3 to -9.3%). The combination of VAN+TZP was significantly higher than VAN+FEP for risk, injury, and failure (see table) despite higher VAN daily doses in the VAN+FEP group (1964mg vs. 2037mg, p<0.0001). There were no significant differences in time to AKI, length of stay, or in-hospital mortality.

    VAN+TZP

    n=1928

    VAN+FEP

    n=648


    p value

    Risk

    328 (17.0%)

    75 (11.6%)

    0.0012

    Injury

    178 (9.2%)

    34 (5.2%)

    0.0019

    Failure

    65 (3.4%)

    10 (1.5%)

    0.0239

    Conclusion: The incidence of AKI was significantly higher in patients receiving VAN in combination with TZP than FEP.

    Jessica Cox, PharmD1, W. Cliff Rutter, PharmD2, Craig Martin, PharmD2, Donna R. Burgess, RPh1, Dominique Zephyr, MA2 and David S. Burgess, PharmD, FCCP2, (1)University of Kentucky HealthCare, Lexington, KY, (2)University of Kentucky, College of Pharmacy, Lexington, KY

    Disclosures:

    J. Cox, None

    W. C. Rutter, None

    C. Martin, None

    D. R. Burgess, None

    D. Zephyr, None

    D. S. Burgess, None

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