1883. Acute Kidney Injury in Patients with Pneumonia on Concomitant Anti-Methicillin Resistant Staphylococcus aureus and Anti-Pseudomonal Beta-Lactam Therapy
Session: Poster Abstract Session: Antimicrobial Stewardship: Potpourri
Saturday, October 6, 2018
Room: S Poster Hall
  • AKI_in_PNA IDWeek2018 FINAL.pdf (367.7 kB)
  • Background: Empiric antibiotic treatment of serious and healthcare associated pneumonia (PNA) often includes coverage of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PSA). Recent publications suggest that patients treated with the combination of vancomycin (V) and piperacillin-tazobactam (PT) have a greater risk of acute kidney injury (AKI) than those treated with V alone, or V in combination with another β-lactam, such as cefepime (C). There is a paucity of data regarding the risk of AKI in other regimens that provide MRSA and PSA coverage, such as linezolid (L)-PT or LC. We examined the incidence of nephrotoxicity in patients who received combination antibiotic therapy for PNA.

    Methods: A retrospective cohort analysis of eligible adult patients (≥ 18 years) admitted from July 1, 2014 to June 30, 2017 who received ≥ 48 hrs of combination therapy was conducted. Patients were excluded if their baseline serum creatinine was ≥ 1.4 mg/dL, on renal replacement therapy, or if diagnosed with cystic fibrosis. The primary outcome was incidence of AKI as defined by RIFLE criteria. Comparisons between the groups were analyzed by Chi-Squared test. To identify variables associated with AKI in a multivariable analysis, a repeated measures, mixed-effects logistic regression was utilized.

    Results: There were 185 patient encounters included in the analysis. RIFLE-defined AKI occurred in treatment groups as follows: VPT 31/98 (31.6%); VC 5/50 (10.0%); LPT 4/12 (33.3%); and LC 4/25 (16.0%). There was a significant difference in rates of AKI among the 4 groups (P=.019). In pooled analyses, no difference was identified between patients receiving V or L (P=.73); however, patients who received PT had a higher incidence of AKI compared to those that received C (P=.002). In logistic regression analyses, independent predictors of AKI were receipt of PT vs C (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.3-8.0) and SOFA score ≥ 9 (OR, 4.5; 95% CI 1.6-12.7).

    Conclusion: No differences in AKI incidence were found between patients receiving vancomycin or linezolid; however, patients receiving piperacillin-tazobactam and those with SOFA scores ≥9 had a higher rate of AKI.

    Brian R. Raux, PharmD1, J. Madison Hyer, MS2, Tiffeny T. Smith, PharmD1, John W. Gnann Jr., MD3 and Shawn H. MacVane, PharmD1, (1)Department of Pharmacy, Medical University of South Carolina, Charleston, SC, (2)Public Health Sciences, Medical University of South Carolina, Charleston, SC, (3)Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC


    B. R. Raux, None

    J. M. Hyer, None

    T. T. Smith, None

    J. W. Gnann Jr., None

    S. H. MacVane, None

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