129. Risk factors for acute kidney injury in patients receiving concomitant vancomycin and piperacillin/tazobactam
Session: Poster Abstract Session: Antimicrobial Stewardship: Adverse Drug Events
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • IDWeek Poster RF for V-Z AKI 2015 final .pdf (210.2 kB)
  • Background:

    Vancomycin (V) and piperacillin/tazobactam (PT) are commonly empirically administered in combination for nosocomial infections. Despite their use in combination for the better part of a decade, recent evidence has suggested that use of V and PT in combination is associated with an increased risk of acute kidney injury (AKI) than monotherapy with either agent. We developed this retrospective case-control study to identify independent predictors of AKI in patients receiving combination therapy with V and PT.

    Methods:

    Patients were eligible for inclusion if they received a minimum of 48 hours of combination treatment at the DMC from December 2011 to December 2013 with V and PT, started within 24 hours of one other. Patients were excluded if they had creatinine >1.2 mg/dL at the start of therapy or if they were receiving renal replacement therapy. Patients were divided into those who developed AKI, defined by the RIFLE crtieria, (cases) and those who did not (controls).  The electronic medical record was accessed to assess potential predictors of AKI, including demographics, co-morbid conditions, severity of illness, vancomycin levels, and receipt of concomitant nephrotoxins. Characteristics associated with AKI in bivariate analysis (p ≤ 0.1) were eligible for inclusion in the multivariate model to identify independent predictors of AKI.

    Results:

    320 patients were included in the cohort and AKI occurred in 105 (33%). The mean age of the cohort was 55 ± 17 years, 150 (47%) were female, 204 (64%) were African American, and 67 (21%) were located in the intensive care unit. Median duration of combination therapy was 5 (IQR 3-6) days in those developing AKI and 4 (IQR 3-6) in those who did not (p < 0.001). In multivariate modeling receipt of a concomitant nephrotoxin (OR 2.1 95% CI 1.2-3.7), the presence of SIRS criteria, receipt of a vancomycin loading dose (OR 2.2 95% CI 1.0 - 4.8), and combination therapy for > 3 days (OR 2.9 95% CI 1.6 - 5.0) were independent predictors of AKI.

    Conclusion:

    Opportunities for limiting the incidence of AKI in patients who are receiving V + PT combination therapy include limiting V loading doses to patients in whom they are warranted; and when indicated, de-escalating or stopping V, PT or both agents on or before day 3 of therapy.

    Jason Pogue, PharmD1, Shigehiko Karinko, MD2, Bhagyashri Navalkele, MD3, Nader Tashtoush, MD4, Bakht Nishan, MD5, Madiha Salim, MD5, Shantanu Solanki, MD3, Amina Pervaiz, MD6, Hamadullah Shaikh, MD3, Sunitha Koppula, MD3 and Keith Kaye, MD, MPH, FIDSA, FSHEA7, (1)Detroit Medical Center/Wayne State University, Detroit, MI, (2)Wayne State University, detroit, MI, (3)Wayne State University, Detroit, MI, (4)Infectious Diseases, Detroit Medical Center/Wayne State University, Detroit, MI, (5)Detroit Medical Center, Detroit, MI, (6)Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI, (7)Medicine, Wayne State University, Detroit, MI

    Disclosures:

    J. Pogue, None

    S. Karinko, None

    B. Navalkele, None

    N. Tashtoush, None

    B. Nishan, None

    M. Salim, None

    S. Solanki, None

    A. Pervaiz, None

    H. Shaikh, None

    S. Koppula, None

    K. Kaye, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.