Risk factors for acute kidney injury associated with the treatment of bacterial endocarditis at a tertiary academic medical center

ABSTRACT Limited literature is available assessing nephrotoxicity with prolonged β-lactam infusions. This study compared the incidence of acute kidney injury (AKI) associated with a prolonged β-lactam infusion or an intermittent infusion. This was a retrospective, matched-cohort study at an academic medical center from July 2006 to September 2015. Adult patients who received piperacillin-tazobactam (TZP), cefepime (FEP), or meropenem (MEM) for at least 48 h were evaluated. Patients were excluded for preexisting renal dysfunction or pregnancy. The primary outcome was difference in incidence of AKI evaluated using the RIFLE (risk, injury, failure, loss, and end-stage) criteria. Patients in the intermittent group were matched 3:1 to patients in the prolonged-infusion group based on the following: β-lactam agent, age, gender, Charlson comorbidity index, baseline creatinine clearance, hypotension, receipt of vancomycin, and treatment in an intensive care unit. A total of 2,390 patients were included in the matched analysis, with 1,700 receiving intermittent infusions and 690 receiving prolonged infusion. The incidence of AKI was similar in the prolonged-infusion group to that in the intermittent-infusion group (21.6% versus 18.6%; P = 0.1). After multivariate regression, prolonged infusion was not associated with increased odds of AKI (odds ratio [OR], 1.07; 95% confidence interval [95% CI], 0.83 to 1.39). Independent predictors of AKI included TZP therapy, concomitant nephrotoxins, hypotension, and heart failure. Although AKIs were numerically more common in patients receiving prolonged β-lactam infusions than those receiving intermittent infusions, prolonged infusion was not an independent risk factor for AKI.

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Prospective Comparison of Acute Kidney Injury During Treatment With the Combination of Piperacillin-Tazobactam and Vancomycin Versus the Combination of Cefepime or Meropenem and Vancomycin

Journal of Pharmacy Practice ◽

10.1177/0897190016628960 ◽

2016 ◽

Vol 30 (2) ◽

pp. 209-213 ◽

Cited By ~ 35

Author(s):

Vincent Peyko ◽

Samantha Smalley ◽

Henry Cohen

Keyword(s):

Acute Kidney Injury ◽

Work Group ◽

Medical Center ◽

Academic Medical Center ◽

Kidney Injury ◽

Adult Patients ◽

Open Label ◽

Prospective Comparison ◽

Academic Medical ◽

Vancomycin Group

Purpose: To prospectively evaluate the observed incidence of acute kidney injury (AKI) in adult patients receiving the combination of piperacillin-tazobactam and vancomycin versus the combination of cefepime or meropenem and vancomycin for greater than 72 hours. Methods: This was a prospective, open-label cohort study at a community academic medical center involving adult patients over a 3-month time period who received either the combination of piperacillin-tazobactam and vancomycin or the combination of cefepime or meropenem and vancomycin for greater than 72 hours. The patients were evaluated for AKI, defined using specific criteria introduced by Kidney Disease: Improving global outcomes (KDIGO) acute kidney injury work group in 2012. Results: A total of 85 patients receiving either antimicrobial combination were evaluated for AKI. The incidence of AKI was significantly higher in the piperacillin-tazobactam and vancomycin group (37.3%) compared with the cefepime or meropenem and vancomycin group (7.7%; χ2 = 7.80, P = .005). Conclusion: The result of this study suggests that the risk of developing AKI is increased in patients receiving the combination of piperacillin-tazobactam and vancomycin versus those receiving the combination of cefepime or meropenem and vancomycin.

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Characteristics of Acute Kidney Injury in Hospitalized COVID-19 Patients in an Urban Academic Medical Center

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.07440520 ◽

2020 ◽

pp. CJN.07440520 ◽

Cited By ~ 1

Author(s):

John R. Lee ◽

Jeffrey Silberzweig ◽

Oleh Akchurin ◽

Mary E. Choi ◽

Vesh Srivatana ◽

...

Keyword(s):

Acute Kidney Injury ◽

Medical Center ◽

Academic Medical Center ◽

Kidney Injury ◽

Academic Medical

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1310. Implementation of AUC:MIC Pharmacy to Dose in an Academic Medical Center: A Pilot Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1492 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S667-S668

Author(s):

Ann-Marie Idusuyi ◽

Maureen Campion ◽

Kathleen Belusko

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Area Under The Curve ◽

Kidney Injury ◽

Retrospective Chart Review ◽

Total Daily Dose ◽

Therapeutic Goals ◽

Academic Medical ◽

Progress Notes ◽

Implementation Period

Abstract Background The new ASHP/IDSA consensus guidelines recommend area under the curve (AUC) monitoring to optimize vancomycin therapy. Little is known about the ability to implement this recommendation in a real-world setting. At UMass Memorial Medical Center (UMMMC), an AUC pharmacy to dose protocol was created to manage infectious diseases (ID) consult patients on vancomycin. The service was piloted by the pharmacy residents and 2 clinical pharmacists. The purpose of this study was to determine if a pharmacy to dose AUC protocol can safely and effectively be implemented. Methods A first-order kinetics calculator was built into the electronic medical record and live education was provided to pharmacists. Pharmacists ordered levels, wrote progress notes, and communicated to teams regarding dose adjustments. Patients were included based upon ID consult and need for vancomycin. After a 3-month implementation period, a retrospective chart review was completed. Patients in the pre-implementation group were admitted 3 months prior to AUC pharmacy to dose, had an ID consult and were monitored by trough (TR) levels. The AUC group was monitored with a steady state peak and trough level to calculate AUC. The primary outcome evaluated time to goal AUC vs. time to goal TR. Secondary outcomes included number of dose adjustments made, total daily dose of vancomycin, and incidence of nephrotoxicity. Results A total of 64 patients met inclusion criteria, with 37 patients monitored by TR and 27 patients monitored by AUC. Baseline characteristics were similar except for weight in kilograms (TR 80.0 ±25.4 vs AUC 92.0 ±26.7; p=0.049). The average time to goal AUC was 4.13 (±2.08) days, and the average time to goal TR was 4.19 (±2.30) days (p=0.982). More dose adjustments occurred in the TR group compared to the AUC (1 vs 2; p=0.037). There was no difference between the two groups in dosing (TR 15.8 mg/kg vs AUC 16.4 mg/kg; p=0.788). Acute kidney injury occurred in 5 patients in the AUC group and 11 patients in the TR group (p=0.765). Conclusion Fewer dose adjustments and less nephrotoxicity was seen utilizing an AUC based protocol. Our small pilot has shown that AUC pharmacy to dose can be safely implemented. Larger studies are needed to evaluate reduction in time to therapeutic goals. Disclosures All Authors: No reported disclosures

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Vancomycin Area Under the Curve Dosing and Monitoring at an Academic Medical Center: Transition Strategies and Lessons Learned

Journal of Pharmacy Practice ◽

10.1177/0897190019834369 ◽

2019 ◽

Vol 33 (6) ◽

pp. 774-778 ◽

Cited By ~ 4

Author(s):

Eric R. Gregory ◽

Donna R. Burgess ◽

Sarah E. Cotner ◽

Jeremy D. VanHoose ◽

Alexander H. Flannery ◽

...

Keyword(s):

Technology Development ◽

Medical Center ◽

Academic Medical Center ◽

Area Under The Curve ◽

Kidney Injury ◽

Lessons Learned ◽

Academic Medical ◽

Transition Strategies ◽

Evaluation Stage ◽

Information Technology Development

Due to the inconsistent correlation of vancomycin trough concentrations with 24-hour area under the curve (AUC) and a desire to reduce rates of vancomycin-associated acute kidney injury, an institutional guideline was implemented by the Antimicrobial Stewardship Team in September 2017 to monitor vancomycin using AUC. Three stages were utilized to organize the process: preparation, implementation, and evaluation. The preparation stage was used to present literature to key stakeholders, and pharmacy meetings focused on the development of a dosing and monitoring guideline. Along with institution-wide education, the implementation stage included information technology development and support. The evaluation stage was comprised of quality improvement and clinical research. Future plans include dissemination of the results and analyses. Numerous lessons were learned due to barriers experienced during the process, but the transition was successful.

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1575. Vancomycin Loading Doses and Nephrotoxicity on Medicine Teaching Services

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1439 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S575-S575

Author(s):

Phillip Wagner ◽

Jon Arnold ◽

Kathleen R Sheridan

Keyword(s):

Drug Exposure ◽

Standard Dose ◽

Medical Center ◽

Academic Medical Center ◽

Kidney Injury ◽

Loading Dose ◽

Academic Medical ◽

Trough Concentrations ◽

Seriously Ill Patients ◽

The Relationship

Abstract Background IDSA guidelines recommend the usage of a loading dose when using vancomycin for seriously ill patients to rapidly achieve adequate trough concentrations. While the relationship between vancomycin and nephrotoxicity is the focus of many studies, and with the strength of that relationship still debated, few studies have examined the relationship between vancomycin loading doses and nephrotoxicity. Methods We performed a retrospective cohort study examining vancomycin dosing for internal medicine teaching services’ patients over the 2014–15 academic year at one academic medical center. We generated a list of all hospitalized patients aged 18–85 who received vancomycin and were admitted to a teaching service. Patient data were extracted from the inpatient EMR via manual chart review. Patients were excluded if their pretreatment calculated glomerular filtration rate (GFR) was less than 50 mL/minute, if they received less than three doses of vancomycin, or if their initial dose was subtherapeutic (<10 mg/kg). Nephrotoxicity was determined by 7-day acute kidney injury (AKI) rate. Patients in the loading dose (>20 mg/kg) cohort were compared with those in the standard dose cohort (10–20 mg/kg). Our primary modeling used multi-variable logistic regression with AKI as our outcome of interest. Results 438 of the initial 804 patients were enrolled. The loading dose (n = 365, 83%) and standard dosing (n = 73, 17%) cohorts were not significantly different regarding demographics, GFR, nephrotoxic drug exposure, total vancomycin received, trough levels, or comorbidities, and were only significantly different regarding body mass index (BMI). The 7-day AKI rate was not significantly different between the two arms (6.3% in the standard dosing arm and 8.2% in the loading dose arm P = 0.6). AKI rate significantly increased in both arms in the setting of concurrent piperacillin–tazobactam and vancomycin administration (OR 2.5, P = .04). There was no association between BMI and AKI. Conclusion Few studies have examined the relationship between nephrotoxicity and vancomycin loading doses. The results of this study provide evidence that the use of loading doses is not significantly associated with increased 7-day AKI rate. Disclosures All authors: No reported disclosures.

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Abstract P5-22-14: Assessment of risk factors in women undergoing contralateral prophylactic mastectomy after breast cancer diagnosis: Experience at an academic medical center

10.1158/1538-7445.sabcs17-p5-22-14 ◽

2018 ◽

Author(s):

A Drobysheva ◽

Y Butt ◽

S Sahoo

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cancer Diagnosis ◽

Prophylactic Mastectomy ◽

Medical Center ◽

Academic Medical Center ◽

Contralateral Prophylactic Mastectomy ◽

Breast Cancer Diagnosis ◽

Academic Medical

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Donor risk factors and recipient clinical impact of positive microbial contamination after bone marrow harvests - a large academic medical center experience

Cytotherapy ◽

10.1016/j.jcyt.2020.03.324 ◽

2020 ◽

Vol 22 (5) ◽

pp. S156-S157

Author(s):

S. Nikiforow ◽

B. King ◽

H. Garrity ◽

C. Rosati ◽

A. Wood ◽

...

Keyword(s):

Risk Factors ◽

Bone Marrow ◽

Microbial Contamination ◽

Medical Center ◽

Academic Medical Center ◽

Clinical Impact ◽

Academic Medical

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An Ophthalmology Resident-Led Quality Improvement Initiative to Decrease the Incidence of Perioperative Corneal Injury

Journal of Academic Ophthalmology ◽

10.1055/s-0039-3400545 ◽

2019 ◽

Vol 11 (02) ◽

pp. e49-e53

Author(s):

Amanda L. Ely ◽

Mark Goerlitz-Jessen ◽

Ingrid U. Scott ◽

Erik Lehman ◽

Tabassum Ali ◽

...

Keyword(s):

Risk Factors ◽

Quality Improvement ◽

Chart Review ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Corneal Injury ◽

Surgical Case ◽

Anesthesia Providers ◽

Academic Medical

Abstract Objective This article evaluates the effectiveness of an ophthalmology resident-led quality improvement (QI) initiative to decrease the incidence of perioperative corneal injury at an academic medical center Design Retrospective chart review. Methods A retrospective chart review was conducted of all surgical cases performed 6 months prior to, and 6 months after, implementation of an ophthalmology resident-led QI initiative at an academic medical center. The QI initiative (which focused on perioperative corneal injury awareness, understanding of risk factors, and presentation of an algorithm designed to prevent perioperative corneal injury) consisted of a lecture and distribution of educational materials to anesthesia providers. Data collected through the chart review included type of surgical case, presence of diabetes mellitus or thyroid disease, patient age and gender, patient positioning (supine, prone, or lateral), level of anesthesia provider training, length of surgical case, surgical service, type of anesthesia, and type (if any) of perioperative eye injury. The rates of perioperative corneal injury pre- versus post-initiative were compared. Results The rates of perioperative corneal injury pre- and post-initiative were 3.7 and 1.9 per 1,000, respectively (p = 0.012). Significant risk factors for perioperative corneal injury include longer duration of surgery (odds ratio [OR] 90–180 vs. < 90 minutes = 4.18, 95% confidence interval [CI] 1.43–12.18; OR > 180 vs. < 90 minutes = 8.56, 95% CI 3.01–24.32; OR > 180 vs. 90–180 = 2.05, 95% CI 1.17–3.58), patient position lateral > prone > supine (OR prone vs. lateral = 0.25, 95% CI 0.09–0.67; OR supine vs. lateral = 0.13, 95% CI 0.07–0.23), nonhead and neck surgeries (OR = 0.32, 95% CI 0.11–0.87), and surgery performed under the general surgery service (OR general surgery service vs. other subspecialty services = 6.50, 95% CI 2.39–24.76). Conclusions An ophthalmology resident-led QI initiative consisting of educating anesthesia providers was associated with a significant decrease in the rate of perioperative corneal injury.

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