scholarly journals 1243. Continuous vs. Intermittent Intraoperative Infusion of Cefazolin on Surgical Site Infections (SSIs) and Acute Kidney Injury in Patients Undergoing Cardiac Procedures

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S447-S448
Author(s):  
Michael Tichy ◽  
Jessica Seidelman ◽  
Sarah S Lewis ◽  
Richard H Drew ◽  
Richard H Drew ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Pediatric Patients ◽  
Kidney Injury ◽  
Surgical Site Infections ◽  
Intermittent Infusion ◽  
University Hospital ◽  
Cardiac Procedures ◽  
Cardiac Bypass ◽  
Quasi Experimental ◽  
Duke University

Abstract Background Continuous infusion cefazolin (CI) has been investigated as a means to optimize antibiotic exposure for prophylaxis against SSI, notably in patients undergoing cardiac procedures involving cardiac bypass (CPB). However, data are limited on its impact on late SSIs and adverse events. In 6/16, the Duke University Hospital (DUH) Antimicrobial Stewardship Team implemented a program to promote CI. We compared the incidence of culture-confirmed SSIs through postoperative day 90 (POD90) between patients receiving either intermittent infusion cefazolin (INT) or CI intraoperatively. We also compared the rate of acute kidney injury (AKI) between groups. Methods This retrospective quasi-experimental design included adult and pediatric patients undergoing cardiac surgery at DUH between March 2014 and August 2018 and receiving intraoperative cefazolin (alone or in combination with other antibiotics). Patients were categorized as CI (having received at least 1 intraoperative CI infusion) or INT. Culture-confirmed SSIs utilizing NHSN definitions were recorded and a relative risk (RR) determined. AKI was defined as a ≥0.3 mg/dL rise in serum creatinine within 2 days postoperatively. Results A total of 2,172 unique surgical procedures (from 2,143 unique patients) were included. Comparisons of groups are summarized in Table 1. Rates of SSIs were 1.1% and 1.6% in the CI and INT groups, respectively (RR [95% confidence interval] for CI 0.73, [0.35, 1.52]). AKI was reported in 12.9% and 17.4% of patients, respectively. Conclusion We were unable to detect a difference in late SSIs between intraoperative CI and INT cefazolin. Differences observed between AKI between groups requires further investigation, but likely impacted by confounders, including pre-existing renal dysfunction. Disclosures All authors: No reported disclosures.

Effectiveness of a vancomycin dosing protocol guided by area under the concentration-time curve to minimal inhibitory concentration (AUC/MIC) with multidisciplinary team support to improve hospital-wide adherence to a vancomycin dosing protocol: A pilot study

2021 ◽  
pp. 1-6
Author(s):  
Panipak Katawethiwong ◽  
Anucha Apisarnthanarak ◽  
Kittiya Jantarathaneewat ◽  
David J. Weber ◽  
David K. Warren ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Multidisciplinary Team ◽  
Kidney Injury ◽  
University Hospital ◽  
Routine Practice ◽  
Post Intervention ◽  
Coagulase Negative Staphylococci ◽  
Time Curve ◽  
Concentration Time ◽  
Quasi Experimental

Abstract Background: Limited data are available on the implementation of an area under the concentration-time curve (AUC)–based dosing protocol with multidisciplinary team (MT) support to improve adherence with vancomycin dosing protocol. Objective: To evaluate the effectiveness of an AUC-based dosing protocol with MT support intervention with adherence to a hospital-wide vancomycin dosing protocol at Thammasat University Hospital. Method: We conducted a quasi-experimental study in patients who were prescribed intravenous vancomycin. The study was divided into 2 periods; (1) the preintervention period when the vancomycin dosing protocol was already applied in routine practice and (2) the post-intervention period when the implementation of an AUC-based dosing protocol with MT support was added to the existing vancomycin dosing protocol. The primary outcome was the rate of adherence, and the secondary outcomes included acute kidney injury events, vancomycin-related adverse events, and 30-day mortality rate. Results: In total, 240 patients were enrolled. The most common infections were skin and soft-tissue infections (24.6%) and bacteremia (24.6%). The most common pathogens were coagulase-negative staphylococci (19.6%) and Enterococcus spp (15.4%). Adherence with the vancomycin dosing protocol was significantly higher in the postintervention period (90.8% vs 55%; P ≤ .001). By multivariate analysis, an AUC-based dosing protocol with MT support was the sole predictor for adherence with the vancomycin dosing protocol (adjusted odds ratio, 10.31; 95% confidence interval, 4.54–23.45; P ≤ .001). The 30-day mortality rate was significantly lower during the postintervention period (8.3% vs 20%; P = .015). Conclusions: AUC-based dosing protocol with MT support significantly improved adherence with vancomycin dosing protocol and was associated with a lower 30-day mortality rate.

scholarly journals Influence of β-Lactam Infusion Strategy on Acute Kidney Injury

2017 ◽  
Vol 61 (10) ◽  
Author(s):  
Sarah E. Cotner ◽  
W. Cliff Rutter ◽  
Donna R. Burgess ◽  
Katie L. Wallace ◽  
Craig A. Martin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Medical Center ◽  
Academic Medical Center ◽  
Kidney Injury ◽  
Intermittent Infusion ◽  
Prolonged Infusion ◽  
Infusion Group ◽  
Academic Medical ◽  
Baseline Creatinine ◽  
End Stage

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.

scholarly journals Incidence of Nephrotoxicity Among Pediatric Patients Receiving Vancomycin With Either Piperacillin–Tazobactam or Cefepime: A Cohort Study

2018 ◽  
Vol 8 (3) ◽  
pp. 221-227 ◽  
Author(s):  
Kathryn M Cook ◽  
Jessica Gillon ◽  
Alison G Grisso ◽  
Ritu Banerjee ◽  
Natalia Jimenez-Truque ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Pediatric Patients ◽  
Kidney Injury ◽  
Matched Cohort ◽  
Matched Cohort Study

In this matched-cohort study of pediatric inpatients, 28.9% of those treated with a combination of piperacillin–tazobactam and vancomycin developed acute kidney injury, compared to 7.9% in those treated with cefepime and vancomycin (P < .001).

Evolution of diagnostic criteria for acute kidney injury in patients with decompensated cirrhosis: A prospective study in a tertiary university hospital

2020 ◽  
Vol 44 (4) ◽  
pp. 551-563
Author(s):  
Nayana Fonseca Vaz ◽  
Vanessa Nogueira Rodrigues da Cunha ◽  
Marlone Cunha-Silva ◽  
Tiago Sevá-Pereira ◽  
Jazon Romilson de Souza Almeida ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Prospective Study ◽  
Diagnostic Criteria ◽  
Kidney Injury ◽  
University Hospital ◽  
Decompensated Cirrhosis ◽  
A Prospective Study

scholarly journals Flash-Like Albuminuria in Acute Kidney Injury Caused by Puumala Hantavirus Infection

Pathogens ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 615
Author(s):  
Paula Mantula ◽  
Johanna Tietäväinen ◽  
Jan Clement ◽  
Onni Niemelä ◽  
Ilkka Pörsti ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Phase ◽  
Kidney Injury ◽  
University Hospital ◽  
Hantavirus Infection ◽  
Puumala Virus ◽  
Disappearance Rate ◽  
Time Points ◽  
Albumin Excretion ◽  
Fever Onset

Transient proteinuria and acute kidney injury (AKI) are characteristics of Puumala virus (PUUV) infection. Albuminuria peaks around the fifth day and associates with AKI severity. To evaluate albuminuria disappearance rate, we quantified albumin excretion at different time points after the fever onset. The study included 141 consecutive patients hospitalized due to acute PUUV infection in Tampere University Hospital, Finland. Timed overnight albumin excretion (cU-Alb) was measured during the acute phase in 133 patients, once or twice during the convalescent phase within three months in 94 patients, and at six months in 36 patients. During hospitalization, 30% of the patients had moderately increased albuminuria (cU-Alb 20–200 μg/min), while 57% presented with severely increased albuminuria (cU-Alb >200 μg/min). Median cU-Alb was 311 μg/min (range 2.2–6460) ≤7 days after fever onset, 235 μg/min (range 6.8–5479) at 8–13 days and 2.8 μg/min (range 0.5–18.2) at 14–20 days. After that, only one of the measurements showed albuminuria (35.4 μg/min at day 44). At six months, the median cU-Alb was 2.0 μg/min (range 0.6–14.5). Albuminuria makes a flash-like appearance in PUUV infection and returns rapidly to normal levels within 2–3 weeks after fever onset. In the case of AKI, this is a unique phenomenon.

scholarly journals Liver Transplant Patients with High Levels of Preoperative Serum Ammonia Are at Increased Risk for Postoperative Acute Kidney Injury: A Retrospective Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1629
Author(s):  
Yoon Sook Lee ◽  
Yoon Ji Choi ◽  
Kyu Hee Park ◽  
Byeong Seon Park ◽  
Jung-Min Son ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Ammonia Level ◽  
University Hospital ◽  
Transplant Patients ◽  
Preoperative Serum ◽  
Increased Risk ◽  
Serum Ammonia ◽  
Postoperative Aki

Acute kidney injury (AKI) is one of the most frequent postoperative complications after liver transplantation (LT). Increased serum ammonia levels due to the liver disease itself may affect postoperative renal function. This study aimed to compare the incidence of postoperative AKI according to preoperative serum ammonia levels in patients after LT. Medical records from 436 patients who underwent LT from January 2010 to February 2020 in a single university hospital were retrospectively reviewed. The patients were then categorized according to changes in plasma creatinine concentrations within 48 h of LT using the Acute Kidney Injury Network criteria. A preoperative serum ammonia level above 45 mg/dL was associated with postoperative AKI (p < 0.0001). Even in patients with a normal preoperative creatinine level, when the ammonia level was greater than 45 μg/dL, the incidence of postoperative AKI was significantly higher (p < 0.0001); the AKI stage was also higher in this group than in the group with preoperative ammonia levels less than or equal to 45 μg/dL (p < 0.0001). Based on the results of our research, an elevation in preoperative serum ammonia levels above 45 μg/dL is related to postoperative AKI after LT.

scholarly journals Acute kidney injury following prophylactic flucloxacillin and gentamicin in primary hip and knee arthroplasty

2020 ◽  
Author(s):  
Judi Graham ◽  
Emma Borthwick ◽  
Christopher Hill ◽  
Janine Blaney ◽  
Nicola Gallagher ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Knee Arthroplasty ◽  
Prophylactic Antibiotic ◽  
Kidney Injury ◽  
Binary Logistic Regression ◽  
Surgical Site Infections ◽  
Ideal Body Weight ◽  
High Dose ◽  
Binary Logistic Regression Model ◽  
Hip And Knee Arthroplasty

Abstract Background Following concerns regarding the emergence of Clostridium difficile infection in 2010, we changed antibiotic prophylaxis in patients undergoing primary hip and knee arthroplasty from cefuroxime to flucloxacillin and single-dose (SD) gentamicin. A subsequent perceived increase in the incidence of post-operative acute kidney injury (AKI) led us to evaluate the AKI incidence between different prophylactic antibiotic regimes used at our centre. Methods We examined the incidence of AKI as defined by Kidney Disease: Improving Global Outcomes criteria in 1588 patients undergoing primary hip or knee arthroplasty from January 2010 to January 2015. Patients received the following prophylactic antibiotic regimes: 8 g flucloxacillin in four divided doses and SD gentamicin 1.5 mg/kg ideal body weight (IBW; maximum dose 120 mg; n = 400), 8 g flucloxacillin alone in four divided doses (n = 400), SD cefuroxime (n = 400), triple-dose (TD) cefuroxime (n = 188) and teicoplanin with SD gentamicin 1.5 mg/kg IBW (n = 200). Results The incidence of AKI was as follows: flucloxacillin and gentamicin (13%); flucloxacillin alone (8.5%); SD cefuroxime (2%); TD cefuroxime (0.5%); and teicoplanin and gentamicin (3%). Of the six patients who developed Stage 3 AKI, all were in the flucloxacillin and gentamicin group. The odds ratio for the development of AKI derived from a binary logistic regression model was highest in the flucloxacillin and gentamicin group [7.79 (95% confidence interval 3.54–17.14), P &lt; 0.0001]. Conclusions Our findings suggest that the use of prophylactic high-dose flucloxacillin and gentamicin should be used with caution in patients undergoing primary hip or knee arthroplasty without a clear advantage in reducing surgical site infections given the association with increased rates of AKI.

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