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.
B. R. Raux,
T. T. Smith, None
J. W. Gnann Jr., None
S. H. MacVane, None