Vancomycin-ResistantEnterococcus faeciumBacteremia in a Tertiary Care Hospital: Epidemiology, Antimicrobial Susceptibility, and Outcome

Vancomycin-resistantEnterococcus faecium(VREF) has emerged as a relevant multidrug-resistant pathogen and potentially lethal etiology of health care associated infections worldwide. The objective of this retrospective cohort study was to assess factors associated with mortality in patients with VREF bacteremia in a major tertiary referral hospital in Southern Brazil. All documented cases of bacteremia identified between May 2010 and July 2012 were evaluated. Cox regression was performed to determine whether the characteristics related to the host or antimicrobial treatment were associated with the all-cause 30-day mortality. In total, 35 patients with documented VREF bacteremia were identified during the study period. The median APACHE-II score of the study population was 26 (interquartile range: 10). The overall 30-day mortality was 65.7%. All VREF isolates were sensitive to linezolid, daptomycin, and quinupristin-dalfopristin. Linezolid was the only antimicrobial agent within vitroactivity against VREF that was administered to the cohort. After multivariate analysis, linezolid treatment (HR, 0.08; 95% CI, 0.02–0.27) and presence of acute kidney injury at the onset of bacteremia (HR, 4.01; 95% CI, 1.62–9.94) were independently associated with mortality. Presentation with acute kidney injury and lack of treatment with an effective antibiotic poses risk for mortality in patients with VREF bacteremia.

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Haemodynamically Unstable Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis: Outcome in an ICU of Bangladesh

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v42i1.31995 ◽

2017 ◽

Vol 42 (1) ◽

pp. 14-20

Author(s):

Kaniz Fatema ◽

Mohammad Omar Faruq

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

De Novo ◽

Tertiary Care ◽

Kidney Injury ◽

Cost Effective ◽

Apache Ii Score ◽

Care Hospital ◽

Low Efficiency

Acute kidney injury (AKI) is a risk factor for increased mortality in critically ill patients. Sustained low efficiency dialysis (SLED) is a new approach in renal replacement therapy (RRT) and it combines the advantages of continuous renal replacement therapy (CRRT) and intermittent haemodialysis (HD). The study was aimed to evaluate the outcome of the hae-modynamically unstable patients with AKI in Bangladesh who were treated with SLED. So far this is the first reported study on SLED in intensive care unit (ICU) in Bangladesh. This quasi-experimental study was conducted in a 10-bed adult ICU of a tertiary care hospital in Bangladesh from June 2012 to May 2013. A total of 153 sessions of SLED were performed on 43 AKI patients. Mean age of the patients was 60.12 ± 15.57 years with male preponder-ance (67.4% were male). Mean APACHE II score was 26.88 ± 6.25. Fourteen patients (32.55%) had de novo AKI. Twenty nine patients (67.4%) had chronic kidney disease (CKD) with baseline mean serum creatinine 2.56 mg/dl, but did not require any RRT before admis-sion in ICU. After giving SLED, AKI of the study patients were completely resolved in 27.9%. Some forty two percent patients became dialysis dependant and 30.23% patients died. Patients who had AKI on CKD became dialysis dependant more often than the patients with de novo AKI (p <0.01). Mortality rate was significantly higher in patients who were on inotrope support (p= 0.017). Otherwise, there was no relation of 28 day mortality with age, prior renal function and mechanical ventilator requirement (p>0.05). Thus, SLED is an excellent renal replacement therapy for the haemodynamically unstable AKI patients of ICU. It is also cost-effective compared to CRRT.

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A nomogram incorporating functional and tubular damage biomarkers to predict the risk of acute kidney injury for septic patients

BMC Nephrology ◽

10.1186/s12882-021-02388-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jianchao Ma ◽

Yujun Deng ◽

Haiyan Lao ◽

Xin Ouyang ◽

Silin Liang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Clinical Utility ◽

Prediction Models ◽

Validation Cohort ◽

Tertiary Care ◽

Kidney Injury ◽

Apache Ii Score ◽

Tubular Damage ◽

Care Hospital ◽

Icu Admission

Abstract Background Combining tubular damage and functional biomarkers may improve prediction precision of acute kidney injury (AKI). Serum cystatin C (sCysC) represents functional damage of kidney, while urinary N-acetyl-β-D-glucosaminidase (uNAG) is considered as a tubular damage biomarker. So far, there is no nomogram containing this combination to predict AKI in septic cohort. We aimed to compare the performance of AKI prediction models with or without incorporating these two biomarkers and develop an effective nomogram for septic patients in intensive care unit (ICU). Methods This was a prospective study conducted in the mixed medical-surgical ICU of a tertiary care hospital. Adults with sepsis were enrolled. The patients were divided into development and validation cohorts in chronological order of ICU admission. A logistic regression model for AKI prediction was first constructed in the development cohort. The contribution of the biomarkers (sCysC, uNAG) to this model for AKI prediction was assessed with the area under the receiver operator characteristic curve (AUC), continuous net reclassification index (cNRI), and incremental discrimination improvement (IDI). Then nomogram was established based on the model with the best performance. This nomogram was validated in the validation cohort in terms of discrimination and calibration. The decision curve analysis (DCA) was performed to evaluate the nomogram’s clinical utility. Results Of 358 enrolled patients, 232 were in the development cohort (69 AKI), while 126 in the validation cohort (52 AKI). The first clinical model included the APACHE II score, serum creatinine, and vasopressor used at ICU admission. Adding sCysC and uNAG to this model improved the AUC to 0.831. Furthermore, incorporating them significantly improved risk reclassification over the predictive model alone, with cNRI (0.575) and IDI (0.085). A nomogram was then established based on the new model including sCysC and uNAG. Application of this nomogram in the validation cohort yielded fair discrimination with an AUC of 0.784 and good calibration. The DCA revealed good clinical utility of this nomogram. Conclusions A nomogram that incorporates functional marker (sCysC) and tubular damage marker (uNAG), together with routine clinical factors may be a useful prognostic tool for individualized prediction of AKI in septic patients.

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Predictors of mortality in acute kidney injury patients admitted to medicine intensive care unit in a Rural Tertiary Care Hospital

Indian Journal of Critical Care Medicine ◽

10.4103/ijccm.ijccm_462_17 ◽

2018 ◽

Vol 22 (4) ◽

pp. 231-237 ◽

Cited By ~ 5

Author(s):

Amrish Saxena ◽

Shrikant Meshram

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Kidney Injury ◽

Care Hospital ◽

Predictors Of Mortality

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Evaluation of Aetiology and Outcome of Acute Kidney Injury in a Tertiary Care Hospital of India- A Prospective Observational Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/45161.13845 ◽

2020 ◽

Author(s):

VS Gaurav Narayan ◽

SG Ramya ◽

Sonal Rajesh Kumar ◽

SK Nellaiappa Ganesan

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Observational Study ◽

Prospective Observational Study ◽

Tertiary Care ◽

Kidney Injury ◽

Rapid Decline ◽

Care Hospital ◽

Medical Intensive Care

Introduction: The Acute Kidney Injury (AKI) is a rapid decline in renal filtration function. The aetiological spectrum, prevalence of AKI and outcome is highly variable. This variation exists due to the difference in the criteria used, study population and demographic features. Huge differences are noted when AKI is compared in developing and developed countries. Hence, it is important to analyse the spectrum of AKI to facilitate earlier diagnosis and treatment which shall help in improving the outcome. Aim: To study the prevalence, aetiology and outcome of AKI in the medical intensive care. Materials and Methods: This was a prospective observational study conducted in a medical intensive care for 18 months where 1490 patients were screened and 403 patients were included as AKI by KDIGO criteria. History, examination, appropriate investigations and treatment details including dialysis were noted. The serum creatinine levels were obtained every day, to know the time of onset of AKI, at the time of death or discharge, and after one month for patients who turned up for follow-up. Patients were categorised based on outcome as survivors and nonsurvivors. Survivors were divided into as fully recovered and partially recovered and those who left the Intensive Care Unit (ICU) against medical advice were termed as lost to follow-up. Results: A total of 403 patients (27.04% of 1490) of medical intensive care admissions were found to have AKI. Sepsis was the most common cause of AKI. At the end of the month, 78.4% of AKI patients fully recovered, 1.2% partially recovered and the mortality was 14.9%. Mortality was higher in AKI associated with chronic medical conditions like cardiac failure, chronic liver disease and stroke. Conclusion: If treated early, AKI is mostly reversible. Regional differences in AKI should be studied extensively and local guidelines should be formulated by experts for prevention and early treatment, to improve the disease outcome.

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A CLINICAL STUDY OF ETIOLOGY, OUTCOME AND PROGNOSTIC FACTORS OF ACUTE KIDNEY INJURY AMONG ICU ADMISSIONS IN RURAL TERTIARY CARE HOSPITAL

10.36106/gjra/9815424 ◽

2021 ◽

pp. 201-204

Author(s):

Shashikantha Shashikantha ◽

Sohil Sharda. ◽

Bernice Robert ◽

Gangurde Bhushan Daulatrao

Keyword(s):

Acute Kidney Injury ◽

Prognostic Factors ◽

Renal Disease ◽

Tertiary Care Hospital ◽

Chronic Renal Disease ◽

Tertiary Care ◽

Ventilatory Support ◽

Kidney Injury ◽

Care Hospital ◽

Study Results

INTRODUCTION: Acute kidney injury is a common occurrence in ICU admissions causing increased morbidity and mortality. Present study aimed to determine the causes and prognostic factors of acute kidney injury in intensive care unit. MATERIAL AND METHODS: This Hospital based Cross sectional Study was conducted at a tertiary care Hospital and Research Center, including 100 patients aged >18 years with Acute Kidney Injury admitted in ICU from the period of October 2018 to June 2020. Patients with chronic renal disease, previous renal transplantation, congenital renal disease were excluded from the study. RESULTS: Most of the patients (63%) were aged above 50 years. Diabetes was found in 55% and hypertension in 26% of AKI cases. Most common cause identied were sepsis, CLD, renal, CNS and CVD. Hypotension occurred in 48% patients, while oliguria occurred in 45% patients. Ventilatory support was required by 43% patients, while 31% patients required haemodialysis. Mortality rate in AKI was 51%. Mortality was signicantly associated with advanced age, presence of Diabetes, and RIFLE criteria. Spot urine <40 meq/L, hyperkalemia, serum creatinine >4 mg/dl, blood urea >100 mg/dl and acidosis were associated with higher mortality. CONCLUSION: Continuous monitoring parameters like Spot Fe Na, Serum Potasium and pH especially in patients at risk, like elderly patients with diabetes, those with sepsis, can help in early identication and appropiate management, thus reduce the incidence or severity of AKI.

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P0643PROGNOSTIC IMPACT OF THROMBOCYTOPENIA IN THE RISK OF INTRAHOSPITAL BLEEDING IN ACUTE KIDNEY INJURY (AKI) PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0643 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Zorica Dimitrijevic ◽

Branka Mitic ◽

Danijela Tasic ◽

Goran Paunovic ◽

Karolina Paunovic ◽

...

Keyword(s):

Acute Kidney Injury ◽

Platelet Count ◽

Major Bleeding ◽

Tertiary Care ◽

Kidney Injury ◽

Bleeding Risk ◽

Prognostic Impact ◽

Care Hospital ◽

Ulcer Disease ◽

Post Surgery

Abstract Background and Aims Low platelet count is a marker of adverse events in acute kidney injury (AKI) patients. Thrombocytopenia has often been reported as an indicator of underlying disease severity and worse patient outcomes; however, it’s role in the prediction of the risk of bleeding is not well defined. Our study aimed to assess the prognostic impact of admission thrombocytopenia in the risk of major bleeding in non-septic, non-post surgery AKI patients. Method This retrospective study enrolled patients with AKI hospitalized at tertiary care hospital during the three years. Admission thrombocytopenia was defined as a platelet count < 150x103/mL. The primary endpoint was major bleeding, as defined by the International Society on Thrombosis and Haemostasis. Results Of 178 included patients (age 61.7±11.1 years; 68.3% males), 26 (14.6%) had thrombocytopenia. These patients had more comorbidities: cancer (19.4 vs 9.6%; p=0.05); previous ulcer disease (17.6 vs. 8.8; p=0.04) and bleeding history (7.4% vs. 2.0%;p=0.04). While in a hospital, there was a trend for the use of more blood transfusions (7.4% vs. 2.7%; p=0.03) and more concomitant medications (12.7 vs. 5.1; p<0.05) in patients with thrombocytopenia. During a hospital stay (IQR: 7-29 days), 19 patients (10.7%) died), 22 (12.35%) had major bleeding, and 5 (2.8%) intracranial bleeding. After adjusting for age, presence of cancer, and use of oral anticoagulant medications, patients with thrombocytopenia had a higher risk of major bleeding (HR 3.34 95%CI: 1.57-7.26; p < 0.001). Conclusion Thrombocytopenia is a predictor of major intrahospital bleeding in the non-septic, non-post surgery AKI patients. It should be regarded in bleeding risk estimation and therapeutic strategy decisions.

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Acute kidney injury requiring dialysis in obstetric patients: management and clinical outcome in case series of 30 patients in a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172923 ◽

2017 ◽

Vol 6 (7) ◽

pp. 2997

Author(s):

Molina U. Patel ◽

Yuvraj Jadeja ◽

Niket Patel ◽

Nayana Patel ◽

Smruti Vaishnav ◽

...

Keyword(s):

Acute Kidney Injury ◽

Tertiary Care ◽

Case Series ◽

Kidney Injury ◽

Therapeutic Interventions ◽

Risk Category ◽

Care Hospital ◽

Tertiary Care Centre ◽

Significant Difference ◽

The Impact

Background: Acute Kidney Injury is a common medical problem affecting approximately 5% of all hospitalized and 30% of critically ill patients. The incidence in obstetric patients ranges from 1 in 2000 to 1 in 25000 pregnancies. In India till date, the impact of AKI on fetomaternal outcome and pertaining therapeutic interventions is only sparsely studied.Methods: It is a retrospective cross-sectional study. All obstetric patients with AKI on dialysis, admitted to Shree Krishna Hospital, a tertiary care hospital in Karamsad village in Gujarat from January 2013 to August 2015. Multivariate statistical analysis of clinical and laboratory parameters was performed using SPSS program to obtain the results.Results: The incidence of dialysis was 1.6%. HELLP syndrome and pre-eclampsia (80%) was found to be the most common etiology of AKI followed by Congestive cardiac failure (34.5%), hemorrhage and sepsis in 30% resp. All patients were admitted to ICU care. No significant difference was found between SAP II and SOFA monitoring system. Mechanical ventilation was done to support 53.3% and inotropic support was needed by 56.7% patients. According to the RIFLE criteria, majority of the patients fall under risk category followed by injury. 18% of the patients developed End Stage Renal Disease.Conclusions: In view of the multifaceted etiologies and complexity of management of AKI, a multi-disciplinary approach involving nephrologist, intensivists, obstetricians and neonatologists is extremely important.

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