Acute kidney injury in non-critically ill children treated with aminoglycoside antibiotics in a tertiary healthcare centre: a retrospective cohort study

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.

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

PLoS ONE ◽

10.1371/journal.pone.0121482 ◽

2015 ◽

Vol 10 (3) ◽

pp. e0121482 ◽

Cited By ~ 6

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

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

Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy ◽

10.1002/phar.1738 ◽

2016 ◽

Vol 36 (5) ◽

pp. 463-471 ◽

Cited By ~ 56

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

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Risk factors for acute kidney injury in critically ill patients receiving high intravenous doses of colistin methanesulfonate and/or other nephrotoxic antibiotics: a retrospective cohort study

Critical Care ◽

10.1186/cc12853 ◽

2013 ◽

Vol 17 (4) ◽

pp. R174 ◽

Cited By ~ 54

Author(s):

Monica Rocco ◽

Luca Montini ◽

Elisa Alessandri ◽

Mario Venditti ◽

Amalia Laderchi ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cohort Study ◽

Critically Ill ◽

Retrospective Cohort Study ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Kidney Injury ◽

Colistin Methanesulfonate

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Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211027759 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110277

Author(s):

Tyler Pitre ◽

Angela (Hong Tian) Dong ◽

Aaron Jones ◽

Jessica Kapralik ◽

Sonya Cui ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cohort Study ◽

Hospital Mortality ◽

Disease Severity ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Kidney Injury ◽

Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

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