Cargando…

610. Incidence of Acute Kidney Injury in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients Receiving Vancomycin

BACKGROUND: Vancomycin therapy is known to be associated with nephrotoxicity. Predictors of nephrotoxicity in outpatients are not well defined and have only been reported in relatively small studies. We examined the factors associated with incidence of nephrotoxicity during outpatient parenteral ant...

Descripción completa

Detalles Bibliográficos
Autores principales: Hamad, Yasir, Nickel, Katelin B, Burnett, Yvonne, Olsen, Margaret A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777684/
http://dx.doi.org/10.1093/ofid/ofaa439.804
_version_ 1783630960097492992
author Hamad, Yasir
Nickel, Katelin B
Burnett, Yvonne
Olsen, Margaret A
author_facet Hamad, Yasir
Nickel, Katelin B
Burnett, Yvonne
Olsen, Margaret A
author_sort Hamad, Yasir
collection PubMed
description BACKGROUND: Vancomycin therapy is known to be associated with nephrotoxicity. Predictors of nephrotoxicity in outpatients are not well defined and have only been reported in relatively small studies. We examined the factors associated with incidence of nephrotoxicity during outpatient parenteral antimicrobial therapy (OPAT) using administrative data. METHODS: A large insurance claims database of privately insured patients (IBM-MarketScan) ages 18 - 64 from 2010 to 2016 was queried for patients discharged from the hospital on vancomycin OPAT. The primary endpoint was 42-day hospital readmission with acute kidney injury (AKI). A Chi-square test was used to examine associations with AKI. Factors with significant associations in univariate analysis were then incorporated into a multivariable logistic regression model. RESULTS: A total of 14,196 patients were included in the study, median age was 54 years and 53.8% were male. Hospital readmission with AKI occurred in 385 (2.7 %). Factors associated with AKI in univariate analysis included older age, living in a rural area, heart failure (CHF), chronic kidney disease (CKD), liver disease, diabetes, cancer, septicemia, MRSA infection, concomitant penicillin therapy, receiving therapy at home versus an infusion center, and infectious diseases consult during index hospitalization. In the multivariable model, septicemia, CHF, CKD, liver disease, and concomitant use of a penicillin family drug were independently associated with increased risk of acute kidney injury (Table). CONCLUSION: Septicemia, use of penicillins and some comorbidities were associated with AKI in patients treated with vancomycin OPAT. Patients at high risk for vancomycin nephrotoxicity should be monitored closely and an alternative therapy should be considered. Table [Image: see text] DISCLOSURES: Margaret A. Olsen, PhD, MPH, Merck (Grant/Research Support)Pfizer (Consultant, Grant/Research Support)
format Online
Article
Text
id pubmed-7777684
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-77776842021-01-07 610. Incidence of Acute Kidney Injury in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients Receiving Vancomycin Hamad, Yasir Nickel, Katelin B Burnett, Yvonne Olsen, Margaret A Open Forum Infect Dis Poster Abstracts BACKGROUND: Vancomycin therapy is known to be associated with nephrotoxicity. Predictors of nephrotoxicity in outpatients are not well defined and have only been reported in relatively small studies. We examined the factors associated with incidence of nephrotoxicity during outpatient parenteral antimicrobial therapy (OPAT) using administrative data. METHODS: A large insurance claims database of privately insured patients (IBM-MarketScan) ages 18 - 64 from 2010 to 2016 was queried for patients discharged from the hospital on vancomycin OPAT. The primary endpoint was 42-day hospital readmission with acute kidney injury (AKI). A Chi-square test was used to examine associations with AKI. Factors with significant associations in univariate analysis were then incorporated into a multivariable logistic regression model. RESULTS: A total of 14,196 patients were included in the study, median age was 54 years and 53.8% were male. Hospital readmission with AKI occurred in 385 (2.7 %). Factors associated with AKI in univariate analysis included older age, living in a rural area, heart failure (CHF), chronic kidney disease (CKD), liver disease, diabetes, cancer, septicemia, MRSA infection, concomitant penicillin therapy, receiving therapy at home versus an infusion center, and infectious diseases consult during index hospitalization. In the multivariable model, septicemia, CHF, CKD, liver disease, and concomitant use of a penicillin family drug were independently associated with increased risk of acute kidney injury (Table). CONCLUSION: Septicemia, use of penicillins and some comorbidities were associated with AKI in patients treated with vancomycin OPAT. Patients at high risk for vancomycin nephrotoxicity should be monitored closely and an alternative therapy should be considered. Table [Image: see text] DISCLOSURES: Margaret A. Olsen, PhD, MPH, Merck (Grant/Research Support)Pfizer (Consultant, Grant/Research Support) Oxford University Press 2020-12-31 /pmc/articles/PMC7777684/ http://dx.doi.org/10.1093/ofid/ofaa439.804 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
Hamad, Yasir
Nickel, Katelin B
Burnett, Yvonne
Olsen, Margaret A
610. Incidence of Acute Kidney Injury in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients Receiving Vancomycin
title 610. Incidence of Acute Kidney Injury in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients Receiving Vancomycin
title_full 610. Incidence of Acute Kidney Injury in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients Receiving Vancomycin
title_fullStr 610. Incidence of Acute Kidney Injury in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients Receiving Vancomycin
title_full_unstemmed 610. Incidence of Acute Kidney Injury in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients Receiving Vancomycin
title_short 610. Incidence of Acute Kidney Injury in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients Receiving Vancomycin
title_sort 610. incidence of acute kidney injury in outpatient parenteral antimicrobial therapy (opat) patients receiving vancomycin
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777684/
http://dx.doi.org/10.1093/ofid/ofaa439.804
work_keys_str_mv AT hamadyasir 610incidenceofacutekidneyinjuryinoutpatientparenteralantimicrobialtherapyopatpatientsreceivingvancomycin
AT nickelkatelinb 610incidenceofacutekidneyinjuryinoutpatientparenteralantimicrobialtherapyopatpatientsreceivingvancomycin
AT burnettyvonne 610incidenceofacutekidneyinjuryinoutpatientparenteralantimicrobialtherapyopatpatientsreceivingvancomycin
AT olsenmargareta 610incidenceofacutekidneyinjuryinoutpatientparenteralantimicrobialtherapyopatpatientsreceivingvancomycin