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50. Comparative Incidence of Acute Kidney Injury in Septic Patients Treated with Vancomycin in Combination with Piperacillin/Tazobactam vs. Cefepime

BACKGROUND: Empiric antibiotic therapy for sepsis of unknown origin is typically broad spectrum and covers P. aeruginosa and methicillin-resistant S. aureus (MRSA). Nephrotoxicity is a well-known adverse event of IV vancomycin and literature suggests that combination with piperacillin/tazobactam may...

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Autores principales: Deja, Erin, Schmidt, Monica, Frens, Jeremy J, Nanavati, Ankit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776909/
http://dx.doi.org/10.1093/ofid/ofaa439.095
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author Deja, Erin
Schmidt, Monica
Frens, Jeremy J
Nanavati, Ankit
author_facet Deja, Erin
Schmidt, Monica
Frens, Jeremy J
Nanavati, Ankit
author_sort Deja, Erin
collection PubMed
description BACKGROUND: Empiric antibiotic therapy for sepsis of unknown origin is typically broad spectrum and covers P. aeruginosa and methicillin-resistant S. aureus (MRSA). Nephrotoxicity is a well-known adverse event of IV vancomycin and literature suggests that combination with piperacillin/tazobactam may increase risk for acute kidney injury (AKI) as compared to combination with other beta-lactams. However, evidence is conflicting. The primary outcome of this study was to compare incidence of AKI in septic patients treated with IV vancomycin and piperacillin/tazobactam (VZ) vs. cefepime (VC). Secondary outcomes include hospital length of stay, inpatient mortality, and impact to direct variable cost. METHODS: Adult patients discharged with a sepsis diagnosis code who received VZ or VC for ≥24 hours in 2012–2019 were retrospectively identified. AKI was defined using RIFLE criteria. Patients were excluded for ESRD on HD, AKI occurring < 48 hours after treatment initiation or >7 days after discontinuation, pregnancy, febrile neutropenia, or meningitis. Statistical analysis controlled for many factors including age, race, gender, Elixhauser comorbidity burden, hours to first antibiotic dose, length of stay, and receipt of concomitant nephrotoxins. RESULTS: A total of 12,405 patients were evaluated; 7,818 received VZ and 3,096 received VC. Patients given VC had a 40% reduction in risk of AKI compared to those given VZ (IRR 0.600; 95% CI 0.46–0.78). These patients also had a 4% reduction in risk of having one additional inpatient day (IRR 0.961; 95% CI 0.937–0.985). Patients who received VZ and experienced AKI were 82.3% more likely to die inpatient compared to patients that did not (IRR 1.822; 95% CI 1.50–2.21). Patients treated with VC incurred less in average direct variable cost than those treated with VZ (p = 0.034) and those who suffered AKI also incurred more on average than those without AKI (p = 0.005). CONCLUSION: Compared to septic patients treated with VZ, those treated with VC had significantly decreased risk of AKI as defined by RIFLE criteria. Patients who received VZ were at higher risk for a longer hospital stay and, if they also experienced AKI, inpatient mortality. VZ was associated with higher direct variable cost and patients with AKI incurred more dollars per encounter than those without AKI. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-77769092021-01-07 50. Comparative Incidence of Acute Kidney Injury in Septic Patients Treated with Vancomycin in Combination with Piperacillin/Tazobactam vs. Cefepime Deja, Erin Schmidt, Monica Frens, Jeremy J Nanavati, Ankit Open Forum Infect Dis Poster Abstracts BACKGROUND: Empiric antibiotic therapy for sepsis of unknown origin is typically broad spectrum and covers P. aeruginosa and methicillin-resistant S. aureus (MRSA). Nephrotoxicity is a well-known adverse event of IV vancomycin and literature suggests that combination with piperacillin/tazobactam may increase risk for acute kidney injury (AKI) as compared to combination with other beta-lactams. However, evidence is conflicting. The primary outcome of this study was to compare incidence of AKI in septic patients treated with IV vancomycin and piperacillin/tazobactam (VZ) vs. cefepime (VC). Secondary outcomes include hospital length of stay, inpatient mortality, and impact to direct variable cost. METHODS: Adult patients discharged with a sepsis diagnosis code who received VZ or VC for ≥24 hours in 2012–2019 were retrospectively identified. AKI was defined using RIFLE criteria. Patients were excluded for ESRD on HD, AKI occurring < 48 hours after treatment initiation or >7 days after discontinuation, pregnancy, febrile neutropenia, or meningitis. Statistical analysis controlled for many factors including age, race, gender, Elixhauser comorbidity burden, hours to first antibiotic dose, length of stay, and receipt of concomitant nephrotoxins. RESULTS: A total of 12,405 patients were evaluated; 7,818 received VZ and 3,096 received VC. Patients given VC had a 40% reduction in risk of AKI compared to those given VZ (IRR 0.600; 95% CI 0.46–0.78). These patients also had a 4% reduction in risk of having one additional inpatient day (IRR 0.961; 95% CI 0.937–0.985). Patients who received VZ and experienced AKI were 82.3% more likely to die inpatient compared to patients that did not (IRR 1.822; 95% CI 1.50–2.21). Patients treated with VC incurred less in average direct variable cost than those treated with VZ (p = 0.034) and those who suffered AKI also incurred more on average than those without AKI (p = 0.005). CONCLUSION: Compared to septic patients treated with VZ, those treated with VC had significantly decreased risk of AKI as defined by RIFLE criteria. Patients who received VZ were at higher risk for a longer hospital stay and, if they also experienced AKI, inpatient mortality. VZ was associated with higher direct variable cost and patients with AKI incurred more dollars per encounter than those without AKI. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7776909/ http://dx.doi.org/10.1093/ofid/ofaa439.095 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Deja, Erin
Schmidt, Monica
Frens, Jeremy J
Nanavati, Ankit
50. Comparative Incidence of Acute Kidney Injury in Septic Patients Treated with Vancomycin in Combination with Piperacillin/Tazobactam vs. Cefepime
title 50. Comparative Incidence of Acute Kidney Injury in Septic Patients Treated with Vancomycin in Combination with Piperacillin/Tazobactam vs. Cefepime
title_full 50. Comparative Incidence of Acute Kidney Injury in Septic Patients Treated with Vancomycin in Combination with Piperacillin/Tazobactam vs. Cefepime
title_fullStr 50. Comparative Incidence of Acute Kidney Injury in Septic Patients Treated with Vancomycin in Combination with Piperacillin/Tazobactam vs. Cefepime
title_full_unstemmed 50. Comparative Incidence of Acute Kidney Injury in Septic Patients Treated with Vancomycin in Combination with Piperacillin/Tazobactam vs. Cefepime
title_short 50. Comparative Incidence of Acute Kidney Injury in Septic Patients Treated with Vancomycin in Combination with Piperacillin/Tazobactam vs. Cefepime
title_sort 50. comparative incidence of acute kidney injury in septic patients treated with vancomycin in combination with piperacillin/tazobactam vs. cefepime
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776909/
http://dx.doi.org/10.1093/ofid/ofaa439.095
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