Comparative Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin-Tazobactam or Cefepime: A Retrospective Cohort Study

2016 ◽  
Vol 36 (5) ◽  
pp. 463-471 ◽  
Author(s):  
Drayton A. Hammond ◽  
Melanie N. Smith ◽  
Jacob T. Painter ◽  
Nikhil K. Meena ◽  
Katherine Lusardi
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Kidney Injury

scholarly journals The Impact of Early Achievement of Therapeutic Levels of Vancomycin in Critically Ill Patients With Confirmed Gram-Positive Infection: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Abdulrahman Alshaya ◽  
Amjad Alsaeed ◽  
Nadiyah Alshehri ◽  
Ramesh Vishwakarma ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Gram Positive ◽  
The Impact ◽  
Trough Levels

Abstract BackgroundVancomycin is a commonly used antibiotic in critically ill patients for various indications. Critical illness imposes pharmacokinetic-pharmacodynamics challenges which makes optimizing vancomycin in this population cumbersome. Data are scarce on the clinical impact of time to therapeutic trough levels of vancomycin in critically ill patients. Objective (s)The aim of this study to evaluate the timing to achieve therapeutic trough level vancomycin on 30-day mortality in critically ill patients.SettingAdult critically ill patients admitted to intensive care units (ICUs) between January 1st, 2017 and December 31st, 2018 at a tertiary teaching hospital.MethodA retrospective cohort study for all adult critically ill patients aged 18 years or older with confirmed gram-positive infection and received vancomycin. We compared early (<48 hours) versus late (≥ 48 hours) attainment of vancomycin therapeutic trough levels. Main outcomesPrimary outcome was the 30-day mortality in critically ill patients. Secondary outcomes were development of resistant organisms, eradicating microorganisms within 4-5 days of vancomycin initiation, vancomycin-induced acute kidney injury (AKI), and ICU LOS. ResultsTwo hundred and nine patients were included. No significant differences between comparative groups in baseline characteristics. Achieving therapeutic levels were associated with better survival at 30 days (OR: 0.48; 95% CI [0.26-0.87]; p<0.01). Additionally, patients who achieved therapeutic levels of vancomycin early were less likely to develop resistant organisms (OR=0.08; 95% CI [0.01-0.59]; p=0.01). Acute kidney injury (AKI) and ICU length of stay (LOS) were not significant between the two groups.ConclusionEarly attainment of vancomycin therapeutic levels was associated with possible survival benefit.

scholarly journals Effect of hyperchloremia on acute kidney injury in critically ill septic patients: a retrospective cohort study

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Lenar Yessayan ◽  
◽  
Javier A. Neyra ◽  
Fabrizio Canepa-Escaro ◽  
George Vasquez-Rios ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Kidney Injury

scholarly journals Long-Term Sequelae of Severe Acute Kidney Injury in the Critically Ill Patient without Comorbidity: A Retrospective Cohort Study

PLoS ONE ◽  
2015 ◽  
Vol 10 (3) ◽  
pp. e0121482 ◽  
Author(s):  
Gijs Fortrie ◽  
Susanne Stads ◽  
Albert-Jan H. Aarnoudse ◽  
Robert Zietse ◽  
Michiel G. Betjes
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Critically Ill Patient

scholarly journals The Impact of Early Achievement of Therapeutic Levels of Vancomycin in Critically ill Patients with Confirmed Gram-positive Infection: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Abdulrahman Alshaya ◽  
Amjad Alsaeed ◽  
Nadiyah Alshehri ◽  
Ramesh Vishwakarma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Gram Positive ◽  
Tertiary Teaching ◽  
The Impact ◽  
Trough Levels

Abstract Background: Vancomycin is a commonly used antibiotic in critically ill patients for various indications. Critical illness imposes pharmacokinetic-pharmacodynamics challenges which makes optimizing vancomycin in this population cumbersome. Data are scarce on the clinical impact of time to therapeutic trough levels of vancomycin in critically ill patients. The aim of this study to evaluate the timing to achieve therapeutic trough level vancomycin on 30-day mortality in critically ill patients.Method: A retrospective cohort study for all adult critically ill patients aged 18 years or older with confirmed Gram-positive infection and received vancomycin between January 1st, 2017 and December 31st, 2018 at a tertiary teaching hospital. We compared early (<48 hours) versus late (≥ 48 hours) attainment of vancomycin therapeutic trough levels. Primary outcome was the 30-day mortality in critically ill patients. Secondary outcomes were development of resistant organisms, eradicating microorganisms within 4-5 days of vancomycin initiation, vancomycin-induced acute kidney injury (AKI), and ICU length of stay (LOS). Results: Two hundred and nine patients were included. No significant differences between comparative groups in baseline characteristics. Achieving therapeutic levels were associated with better survival at 30 days (OR: 0.48; 95% CI [0.26-0.87]; p<0.01). Additionally, patients who achieved therapeutic levels of vancomycin early were less likely to develop resistant organisms (OR=0.08; 95% CI [0.01-0.59]; p=0.01). The AKI and ICU LOS were not significant between the two groups.Conclusion: Early attainment of vancomycin therapeutic levels was associated with possible survival benefit.

scholarly journals The impact of early target attainment of vancomycin in critically ill patients with confirmed Gram-positive infection: A retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Abdulrahman Alshaya ◽  
Ohoud Aljuhani ◽  
Amjad Alsaeed ◽  
Nadiyah Alshehri ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Gram Positive ◽  
The Impact ◽  
Trough Levels

Abstract Background Vancomycin is a commonly used antibiotic in critically ill patients for various indications. Critical illness imposes pharmacokinetic-pharmacodynamics challenges, which makes optimizing vancomycin in this population cumbersome. Data are scarce on the clinical impact of time to therapeutic trough levels of vancomycin in critically ill patients.  This study aims to evaluate the timing to achieve therapeutic trough level of vancomycin on 30-day mortality in critically ill patients. Method A retrospective cohort study was conducted for all adult critically ill patients with confirmed Gram-positive infection who received IV vancomycin between January 1, 2017, and December 31, 2020. We compared early (< 48 h) versus late (≥ 48 h) attainment of vancomycin therapeutic trough levels. The primary outcome was the 30-day mortality in critically ill patients. Secondary outcomes were the development of resistant organisms, microorganisms eradication within 4–5 days of vancomycin initiation, acute kidney injury (AKI), and length of stay (LOS). Propensity score-matched (1:1 ratio) used based on patient’s age, serum creatinine, and albumin values at baseline. Results A total of 326 patients were included; 110 patients attained the therapeutic trough levels within 48 h of vancomycin initiation. Late achievement of the therapeutic trough levels was associated with higher 30-day mortality (HR: 2.54; 95% CI [1.24–5.22]; p = 0.01). Additionally, patients who achieved therapeutic trough levels of vancomycin late were more likely to develop AKI (OR = 2.59; 95% CI [1.01–6.65]; p = 0.04). Other outcomes were not statistically significant between the two groups. Conclusion Early achievement of vancomycin therapeutic levels in patients with confirmed Gram-positive infection was associated with possible survival benefits.

Comparisons of Colistin-Induced Nephrotoxicity Between Two Different Formulations of Colistin in Critically Ill Patients: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Jia-Yih Feng ◽  
Yi-Tzu Lee ◽  
Shen-Wei Pan ◽  
Kuang-Yao Yang ◽  
Yuh-Min Chen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Clinical Factors ◽  
Factors Associated ◽  
Treatment Comparisons

Abstract BackgroundColistin is widely used for the treatment of nosocomial infections caused by carbapenem-resistant gram-negative bacilli (CR-GNB). Colistin-induced nephrotoxicity is one of the major adverse reactions during colistin treatment. Comparisons of colistin-induced nephrotoxicity between different formulations of colistin are rarely reported. MethodsWe conducted a retrospective cohort study that enrolled ICU-admitted patients with cultured isolates of CR-GNB and treatment with intravenous colistin. Occurrences of acute kidney injury (AKI) during treatment with intravenous colistin were recorded. Colistin-induced nephrotoxicity between two formulations of colistin, Locolin® and Colimycin®, were compared. The treatment outcomes associated with the occurrence of colistin-induced nephrotoxicity were also investigated.ResultsA total of 195 patients, 95 treated with Locolin® and 100 treated with Colimycin®, were included for analysis. Patients treated with Locolin® had a higher rate of occurrence of stage 2 (46.3% vs. 32%, p=0.040) and stage 3 (29.5% vs. 13%, p=0.005) AKI than did those treated with Colimycin®. In multivariate analysis, the presence of septic shock (adjusted odds ratio (aOR) 2.07, 95% confidence interval (CI) 1.05–4.06), and inappropriate colistin dosage (aOR 2.49, 95% CI 1.01–60.16) were clinical factors associated with colistin-induced nephrotoxicity. Treatment with Colimycin® was an independent factor associated with a lower risk of colistin-induced nephrotoxicity (aOR 0.36, 95% CI 0.17-0.74). Other clinical factors associated with colistin-induced nephrotoxicity included the presence of septic shock (aOR 2.17, 95% CI 1.10-4.26) and inappropriate colistin dosage (aOR 2.52, 95% CI 1.00-6.33). A comparable mortality rate was noted between patients with and without colistin-induced nephrotoxicity. ConclusionsThe risk of colistin-induced nephrotoxicity significantly varied in different formulations of colistin in critically ill patients. Colistin-induced nephrotoxicity was not associated with increased mortality.

scholarly journals Comparison of colistin-induced nephrotoxicity between two different formulations of colistin in critically ill patients: a retrospective cohort study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jia-Yih Feng ◽  
Yi-Tzu Lee ◽  
Sheng-Wei Pan ◽  
Kuang-Yao Yang ◽  
Yuh-Min Chen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Carbapenem Resistant ◽  
Intravenous Treatment ◽  
Treatment Comparisons

Abstract Background Colistin is widely used in the treatment of nosocomial infections caused by carbapenem-resistant gram-negative bacilli (CR-GNB). Colistin-induced nephrotoxicity is one of the major adverse reactions during colistin treatment. Comparisons of colistin-induced nephrotoxicity between different formulations of colistin are rarely reported. Methods In this retrospective cohort study, we enrolled intensive care unit–admitted patients if they had culture isolates of CR-GNB and underwent intravenous treatment with colistin. The occurrence of acute kidney injury (AKI) during intravenous treatment with colistin was recorded. The occurrence of colistin-induced nephrotoxicity was compared between two formulations of colistin, Locolin®, and Colimycin®. Treatment outcomes associated with the occurrence of colistin-induced nephrotoxicity were also investigated. Results Among 195 patients, 95 who were treated with Locolin® and 100 who were treated with Colimycin® were included for analysis. Patients treated with Locolin® had a higher rate of occurrence of stage 2 (46.3% vs. 32%, p = 0.040) and stage 3 (29.5% vs. 13%, p = 0.005) AKI than did those treated with Colimycin®. In multivariate analysis, the presence of septic shock (adjusted odds ratio [aOR] 2.17, 95% confidence interval [CI] 1.10–4.26) and inappropriate colistin dosage (aOR 2.52, 95% CI 1.00–6.33) were clinical factors associated with colistin-induced nephrotoxicity. Treatment with Colimycin® was an independent factor associated with a lower risk of colistin-induced nephrotoxicity (aOR 0.37, 95% CI 0.18–0.77). The mortality rate was comparable between patients with and without colistin-induced nephrotoxicity. Conclusions The risk of colistin-induced nephrotoxicity significantly varied in different formulations of colistin in critically ill patients. Colistin-induced nephrotoxicity was not associated with increased mortality rate.

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