2386. Antibiotic-Associated Acute Kidney Injury in Hospitalized Children
Session: Oral Abstract Session: Pediatric Antimicrobial Stewardship: Controlling the Bugs and the Dollars
Saturday, October 29, 2016: 2:00 PM
Room: 275-277
Background: Acute kidney injury is a potential adverse effect of IV antimicrobial use. We sought to identify factors and antibiotics associated with antibiotic-associated AKI (AA-AKI) in children.

Methods: We identified all children 6m-18y who received IV antibiotics on hospital days (HD) 1 & 2 from Jan 2007-Dec 2012 using the Pediatric Health Information System Plus database, which includes administrative and laboratory data from 6 large U.S. children’s hospitals. We defined AKI using the KDIGO definition: rise in serum creatinine (SCr) by ≥50% from baseline, or ≥0.3 mg/dL within 48h. The primary outcome was antibiotic-associated AKI (AA-AKI) defined as AKI on HD 3-7. Baseline SCr was defined as lowest on HD 0-2 or median SCr for age and gender if not done HD 0-2. Patients with diagnoses/procedures related to underlying/chronic kidney disease or with AKI on HD 0-2 were excluded.

Results: We identified 20,542 patients who received antibiotics on HD 1 & 2, 4.5% of whom had AA-AKI.The median age of patients was 7.1y (IQR 2.5-13.5y) and 53% were male. Patients with AA-AKI were older (9.3 v 7.0y, p<.001), were more often in the ICU on HD 1&2 (6.5% v 4.2%, p<.001), had an ICD-9 code for sepsis (8.1% v 4.2%, p<.001), had received a solid organ transplant (8.5% v 4.3%, p<.001), and received ≥2 concomitant nephrotoxins on HD 1&2 (7.3% v 4.0%, p<.001). Antibiotics most often associated with AA-AKI were vancomycin (375/4982, 7.5%) and piperacillin/tazobactam (TZP; 238/3414, 7.0%) while patients receiving vancomycin and TZP concurrently on HD 1 & 2 had the highest rate of AA-AKI (151/1203, 12.6%). The combination of vancomycin plus TZP was independently associated with AA-AKI compared to vancomycin alone, adjusting for ICU admission, age, diagnosis of sepsis, and receipt of other nephrotoxins (OR 2.75, CI 1.96-3.88). Ceftriaxone, ceftazidime, cefepime and meropenem did not increase the risk of AA-AKI in patients receiving vancomycin compared to those receiving vancomycin alone. Patients admitted to the ICU who had AA-AKI had higher mortality than those without (15.5% vs 6.2%, p<.01).

Conclusion: Vancomycin and TZP were associated with increased rates of AA-AKI. The use of TZP may increase the risk of AA-AKI compared to comparable beta-lactams in children receiving vancomycin.

Kevin Downes, MD1, Carter Cowden, MPH2, Benjamin Laskin, MD, MS3, Wu Gong, PhD4, Yuan-Shung Huang, MS5, Brian T. Fisher, DO, MSCE, MPH6, Stuart Goldstein, MD7 and Theoklis Zaoutis, MD, MSCE5, (1)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, (3)Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, (4)Health Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, (5)The Children's Hospital of Philadelphia, Philadelphia, PA, (6)Division of Infectious Diseases, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, Center for Clinical Epidemiology and Biostatistics, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, (7)Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Disclosures:

K. Downes, Merck & Co: Investigator , Research grant
Pfizer Inc.: Investigator , Research grant

C. Cowden, None

B. Laskin, None

W. Gong, None

Y. S. Huang, None

B. T. Fisher, Merck & Co.: Investigator , Research grant
Pfizer Inc.: Investigator , Research grant
Ansun BioPharma: Investigator , Research grant

S. Goldstein, None

T. Zaoutis, merck: Grant Investigator , Research grant
T2 biosystems: Consultant , Consulting fee

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