Sarah C J Jorgensen1, Kyle P Murray2, Abdalhamid M Lagnf1, Sarah Melvin1, Sahil Bhatia1, Muhammad-Daniayl Shamim1, Jordan R Smith3,4, Karrine D Brade5, Samuel P Simon6, Jerod Nagel7, Karen S Williams8, Jessica K Ortwine9, Michael P Veve10,11, James Truong12, David B Huang13,14, Susan L Davis1,15, Michael J Rybak16,17,18. 1. Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA. 2. Detroit Medical Center, Detroit, MI, USA. 3. Fred Wilson School of Pharmacy, High Point University, High Point, NC, USA. 4. Cone Health, Greensboro, NC, USA. 5. Boston Medical Center, Boston, MA, USA. 6. Maimonides Medical Center, Brooklyn, NY, USA. 7. University of Michigan, Ann Arbor, MI, USA. 8. Guthrie Robert Packer Hospital, Sayre, PA, USA. 9. Parkland Memorial Hospital, Dallas, TX, USA. 10. College of Pharmacy, University of Tennessee Health Sciences Center, Knoxville, TN, USA. 11. University of Tennessee Medical Center, Knoxville, TN, USA. 12. The Brooklyn Hospital Center, Brooklyn, NY, USA. 13. Motif BioSciences, Princeton, NJ, USA. 14. Rutgers New Jersey Medical School, Trenton, NJ, USA. 15. Henry Ford Health-System, Detroit, MI, USA. 16. Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA. m.rybak@wayne.edu. 17. Detroit Medical Center, Detroit, MI, USA. m.rybak@wayne.edu. 18. School of Medicine, Wayne State University, Detroit, MI, USA. m.rybak@wayne.edu.
Abstract
BACKGROUND: We sought to determine the real-world incidence of and risk factors for vancomycin-associated acute kidney injury (V-AKI) in hospitalized adults with acute bacterial skin and skin structure infections (ABSSSI). METHODS: Retrospective, observational, cohort study at ten U.S. medical centers between 2015 and 2019. Hospitalized patients treated with vancomycin (≥ 72 h) for ABSSSI and ≥ one baseline AKI risk factor were eligible. Patients with end-stage kidney disease, on renal replacement therapy or AKI at baseline, were excluded. The primary outcome was V-AKI by the vancomycin guidelines criteria. RESULTS: In total, 415 patients were included. V-AKI occurred in 39 (9.4%) patients. Independent risk factors for V-AKI were: chronic alcohol abuse (aOR 4.710, 95% CI 1.929-11.499), no medical insurance (aOR 3.451, 95% CI 1.310-9.090), ICU residence (aOR 4.398, 95% CI 1.676-11.541), Gram-negative coverage (aOR 2.926, 95% CI 1.158-7.392) and vancomycin duration (aOR 1.143, 95% CI 1.037-1.260). Based on infection severity and comorbidities, 34.7% of patients were candidates for oral antibiotics at baseline and 39.3% had non-purulent cellulitis which could have been more appropriately treated with a beta-lactam. Patients with V-AKI had significantly longer hospital lengths of stay (9 vs. 6 days, p = 0.001), higher 30-day readmission rates (30.8 vs. 9.0%, p < 0.001) and increased all-cause 30-day mortality (5.1 vs. 0.3%, p = 0.024) CONCLUSIONS: V-AKI occurred in approximately one in ten ABSSSI patients and may be largely prevented by preferential use of oral antibiotics whenever possible, using beta-lactams for non-purulent cellulitis and limiting durations of vancomycin therapy.
BACKGROUND: We sought to determine the real-world incidence of and risk factors for vancomycin-associated acute kidney injury (V-AKI) in hospitalized adults with acute bacterial skin and skin structure infections (ABSSSI). METHODS: Retrospective, observational, cohort study at ten U.S. medical centers between 2015 and 2019. Hospitalized patients treated with vancomycin (≥ 72 h) for ABSSSI and ≥ one baseline AKI risk factor were eligible. Patients with end-stage kidney disease, on renal replacement therapy or AKI at baseline, were excluded. The primary outcome was V-AKI by the vancomycin guidelines criteria. RESULTS: In total, 415 patients were included. V-AKI occurred in 39 (9.4%) patients. Independent risk factors for V-AKI were: chronic alcohol abuse (aOR 4.710, 95% CI 1.929-11.499), no medical insurance (aOR 3.451, 95% CI 1.310-9.090), ICU residence (aOR 4.398, 95% CI 1.676-11.541), Gram-negative coverage (aOR 2.926, 95% CI 1.158-7.392) and vancomycin duration (aOR 1.143, 95% CI 1.037-1.260). Based on infection severity and comorbidities, 34.7% of patients were candidates for oral antibiotics at baseline and 39.3% had non-purulent cellulitis which could have been more appropriately treated with a beta-lactam. Patients with V-AKI had significantly longer hospital lengths of stay (9 vs. 6 days, p = 0.001), higher 30-day readmission rates (30.8 vs. 9.0%, p < 0.001) and increased all-cause 30-day mortality (5.1 vs. 0.3%, p = 0.024) CONCLUSIONS: V-AKI occurred in approximately one in ten ABSSSI patients and may be largely prevented by preferential use of oral antibiotics whenever possible, using beta-lactams for non-purulent cellulitis and limiting durations of vancomycin therapy.
Authors: Sara Alosaimy; Kyle P Murray; Evan J Zasowski; Taylor Morrisette; Abdalhamid M Lagnf; Thomas P Lodise; Michael J Rybak Journal: Clin Infect Dis Date: 2021-12-06 Impact factor: 9.079