125. Incidence of Acute Kidney Injury in Patients Treated with Vancomycin and Piperacillin/Tazobactam
Session: Poster Abstract Session: Antimicrobial Stewardship: Adverse Drug Events
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • AKI poster_final.pdf (475.3 kB)
  • Background: Vancomycin (VAN) associated nephrotoxicity is a widely recognized consequence of current dosing strategies; however, the addition of anti-pseudomonal beta-lactam agents may increase the incidence of acute kidney injury (AKI). This study evaluated the difference in AKI incidence between VAN and piperacillin/tazobactam (PTZ) when used alone and in combination.

    Methods: Clinical data from 9/1/10 through 8/31/14 were obtained from the University of Kentucky Center for Clinical and Translational Science Enterprise Data Trust. Basic descriptive statistics were performed and multivariable logistic regression analysis was utilized to identify risk factors for AKI.

    Results: Overall, 10,445 patients were evaluated, 4892 received PTZ and VAN (PTZ/VAN), 2830 received PTZ alone, and 2723 received VAN alone. Table 1 contains basic demographic information. RIFLE-defined AKI occurred in 1934 (19%) across the entire cohort. AKI occurred in 27% of PTZ/VAN patients, 12% of PTZ patients, and 11% of VAN patients (p<0.0001). RIFLE-defined Risk, Injury, and Failure occurred more frequently in the PTZ/VAN cohort compared to the PTZ and VAN monotherapy groups. After multiple logistic regression, PTZ/VAN therapy was associated with increased odds of AKI compared to PTZ and VAN monotherapies (ORPTZ = 1.69; 95% CIPTZ 1.44-1.98; ORVAN= 1.94; 95%CIVAN1.67-2.26). No difference in AKI incidence was observed between PTZ and VAN groups. Supratherapeutic VAN levels were associated with increased AKI (OR = 2.92; 95% CI 2.42-3.53), while subtherapeutic levels were associated with less AKI incidence (OR = 0.62; 95% CI 0.48-0.81). Known nephrotoxins, increased baseline severity of illness, increased days of therapy, and hypotension exposure were independently associated with increased AKI incidence.

    Conclusion: After controlling for confounders, the combination of PTZ and VAN is associated with increased AKI incidence compared to VAN and PTZ monotherapies.

    Table 1

    PTZ/VAN

    PTZ

    VAN

    p-value

    Age (Mean±SD)

    51.8 (16.2)

    53.3 (17.5)

    52.3 (16.9)

    0.0004

    Male gender, N (%)

    2892 (59.1)

    1367 (48.3)

    1284 (47.2)

    <0.0001

    Charlson (Mean±SD)

    3.67 (3.53)

    3.34 (3.61)

    2.60 (3.05)

    <0.0001

    Baseline creatinine clearance (Mean±SD)

    101.6 (48.7)

    100.1 (88.0)

    100.4 (42.5)

    0.5

    W. Cliff Rutter, PharmD1, Jeffrey C. Talbert, PhD2,3 and David S. Burgess, PharmD, FCCP1, (1)University of Kentucky, College of Pharmacy, Lexington, KY, (2)Center for Clinical and Translational Science, University of Kentucky, Lexington, KY, (3)Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, College of Pharmacy, Lexington, KY

    Disclosures:

    W. C. Rutter, None

    J. C. Talbert, None

    D. S. Burgess, None

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