Risk Factors Associated With Nephrotoxicity During Outpatient Intravenous Vancomycin Administration

2021 ◽  
pp. 875512252110543
Author(s):  
Karen M. Krueger ◽  
Lisa LaCloche ◽  
Amy Buros Stein ◽  
Ryan Kates ◽  
Milena Murray ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Outpatient Setting ◽  
Intravenous Antibiotic ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Intravenous Antibiotics ◽  
Vancomycin Trough ◽  
Control Study

Background: Many studies have described an association between intravenous vancomycin and nephrotoxicity; however, the majority have evaluated incidence and risk factors among hospitalized patients. Outpatient administration of intravenous antibiotics is a growing practice and presents its own set of unique challenges. Objective: The aim of this study was to identify risk factors for vancomycin-associated nephrotoxicity in the outpatient setting. Methods: A case-control study of patients who received intravenous vancomycin through an Outpatient Parenteral Antimicrobial Therapy (OPAT) program was conducted. Patients were identified who developed an acute kidney injury (AKI) during treatment. The primary outcome was the incidence of AKI during treatment. Results: A total of 37 out of 130 patients (28.5%) met the criteria for AKI. AKI was more likely to occur in patients with a longer duration of therapy, higher maximum trough concentration, co-administration of a fluoroquinolone or metronidazole, and those who received another potentially nephrotoxic medication. Co-administration of a fluoroquinolone (OR = 5.96, P = 0.009, [CI: 1.59, 24.38]), any nephrotoxic medication (OR = 11.17, P < 0.001, [CI 3.14, 51.23]), and a higher maximum vancomycin trough (OR = 1.29, P < 0.001, [CI 1.17, 1.44]) were all indicative of a higher odds of an AKI. Conclusion: In this cohort, vancomycin-associated nephrotoxicity was common during outpatient intravenous antibiotic therapy. Co-administration of a fluoroquinolone, any nephrotoxic medication, and a higher maximum vancomycin trough were associated with AKI development. Further study is needed to determine how this impacts long-term clinical outcomes and what measures can be taken to reduce nephrotoxicity risk.

scholarly journals Experience with Liposomal Amphotericin B in Outpatient Parenteral Antimicrobial Therapy (OPAT)

2021 ◽  
Author(s):  
Yvonne J. Burnett ◽  
Andrej Spec ◽  
Mohamed M. Ahmed ◽  
William G. Powderly ◽  
Yasir Hamad
Keyword(s):  
Amphotericin B ◽  
Antimicrobial Therapy ◽  
Liposomal Amphotericin ◽  
Kidney Injury ◽  
Outpatient Setting ◽  
Primary Objective ◽  
Liposomal Amphotericin B ◽  
Close Monitoring ◽  
Outpatient Parenteral Antimicrobial Therapy

Background: Outpatient parenteral antimicrobial therapy (OPAT) is a safe, effective, and convenient treatment strategy for patients receiving intravenous antimicrobials in the outpatient setting; however, data is limited describing the use and safety of liposomal amphotericin B (L-AMB). Methods: Records of patients receiving L-AMB OPAT between 1/1/2015 and 7/31/2018 were retrospectively reviewed. The primary objective was to describe the OPAT patient population discharged on L-AMB and evaluate factors associated with readmission and adverse events (AE). Analysis was performed to evaluate for predictors of worse outcomes. Results: Forty-two patients (67% male, median age 50 years) were identified, most commonly treated for histoplasmosis. The most common doses of L-AMB were 3 mg/kg (n=16, 38%) or 5 mg/kg (n=14, 33%) based on actual body weight. Twenty-six (62%) patients completed their anticipated course of L-AMB. Twenty-two (52%) patients were readmitted within 30 days of discharge, median time to readmission was 11 days (Interquartile range [IQR] 5-18). While hypokalemia and acute kidney injury (AKI) were common, occurring in 26 (62%) and 20 (48%), respectively, only 5 (12%) were readmitted to the hospital due L-AMB-associated AE. Ninety percent of patients achieved at least partial renal recovery within 30 days after L-AMB discontinuation. Factors significantly associated with AKI include higher L-AMB dose, lower serum potassium levels after therapy initiation, and receipt of potassium supplementation at discharge. Conclusion: L-AMB is associated with significant AEs; however, these results suggest treatment is feasible in the outpatient setting with close monitoring, as the majority of AEs were managed effectively as an outpatient without long-term sequelae.

scholarly journals Preventing Contrast-induced Renal Failure: A Guide

2016 ◽  
Vol 11 (2) ◽  
pp. 98 ◽  
Author(s):  
Michela Faggioni ◽  
◽  
Roxana Mehran ◽  
Keyword(s):  
Risk Factors ◽  
Renal Damage ◽  
Preventive Measures ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Kidney Dysfunction ◽  
Percutaneous Coronary ◽  
Patients At Risk ◽  
Short And Long Term

Contrast-induced acute kidney injury (CI-AKI) is characterised by a rapid deterioration of renal function within a few days of parenteral administration of contrast media (CM) in the absence of alternative causes. CI-AKI is the most common form of iatrogenic kidney dysfunction with an estimated prevalence of 12 % in patients undergoing percutaneous coronary intervention. Although usually selfresolving, in patients with pre-existing chronic kidney disease (CKD) or concomitant risk factors for renal damage, CI-AKI is associated with increased short- and long-term morbidity and mortality. Therefore, risk stratification based on clinical and peri-procedural characteristics is crucial in selecting patients at risk of CI-AKI who would benefit the most from implementation of preventive measures.

scholarly journals Risk Factors for Long-Term Mortality and Progressive Chronic Kidney Disease Associated With Acute Kidney Injury After Cardiac Surgery

Medicine ◽  
2015 ◽  
Vol 94 (45) ◽  
pp. e2025 ◽  
Author(s):  
Jia-Rui Xu ◽  
Jia-Ming Zhu ◽  
Jun Jiang ◽  
Xiao-Qiang Ding ◽  
Yi Fang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Long Term Mortality

scholarly journals 538. Extended-Spectrum β-Lactamase (ESBL): Producing Enterobacteriaceae Surveillance Pilot, New Mexico, 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S257-S257
Author(s):  
Erin C Phipps ◽  
Kristina Flores ◽  
Emily B Hancock
Keyword(s):  
Risk Factors ◽  
New Mexico ◽  
Medical Record ◽  
Outpatient Setting ◽  
International Travel ◽  
Care Hospital ◽  
E Coli ◽  
Extended Spectrum ◽  
Incident Cases

Abstract Background Extended-spectrum β-lactamase – producing (ESBL) Enterobacteriaceae pose a serious antibiotic resistance threat, yet gaps remain in our understanding of their epidemiology. New Mexico was one of five Emerging Infection Program (EIP) sites to participate in a surveillance pilot from October 1 to December 31, 2017. Methods A case was defined as a resident of Bernalillo County, NM with E. coli, Klebsiella pneumoniae, or Klebsiella oxytoca cultured from urine or normally sterile body sites resistant to at least one extended-spectrum cephalosporin and nonresistant to all carbapenem antibiotics tested. EIP staff assessed prior healthcare exposures, risk factors, and outcomes through medical record review. Results NM EIP identified 309 incident cases among 288 individuals; 263 medical records were reviewed. Cases ranged in age from 3–95 years, with a median age of 63 years. Most isolates were E. coli (n = 270, 87.4%); 35 (11.3%) were K. pneumoniae and 4 (1.3%) were K. oxytoca. The majority of isolates were cultured from urine (297, 96.1%). Blood cultures comprised 11 cases (3.6%). The majority of ESBL cultures were collected in an outpatient setting; 15% were collected from hospital inpatients and fewer than 5% from residents of a long-term care facility (LTCF) or long-term acute care hospital (LTACH). However, 21% of those collected in an outpatient setting, primarily the ED, were hospitalized within 30 days. Over 60% of the cases had at least one relevant risk factor documented in their medical record. One-third had documented antimicrobial use in the prior month, 39% had been hospitalized in the year prior, and 19% had a urinary catheter in place in the 2 days prior to culture collection. Interestingly, while only 2% had documentation of international travel in the two months prior to culture, 18% had either documented international travel outside of that timeframe, or required the use of language interpretation, possibly indicating extensive time living internationally in the past. Conclusion Among residents of Bernalillo County, NM, ESBL isolates were predominantly E. coli, cultured from urine in outpatient settings. Over half had documentation of recognized risk factors, including prior hospitalizations, recent antibiotic use, or presence of indwelling devices. Disclosures All authors: No reported disclosures.

Infection of totally implantable venous access devices: A review of the literature

2018 ◽  
Vol 19 (3) ◽  
pp. 230-242 ◽  
Author(s):  
Fulvio Pinelli ◽  
Elena Cecero ◽  
Dario Degl’Innocenti ◽  
Valentina Selmi ◽  
Rosa Giua ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Access ◽  
Outpatient Setting ◽  
Intravenous Therapy ◽  
Access Device ◽  
Venous Access Device ◽  
Treatment Of Infection ◽  
Venous Access Devices

Totally implantable venous access devices, or ports, are essential in the therapeutic management of patients who require long-term intermittent intravenous therapy. Totally implantable venous access devices guarantee safe infusion of chemotherapy, blood transfusion, parenteral nutrition, as well as repeated blood samples. Minimizing the need for frequent vascular access, totally implantable venous access devices also improve the patient’s quality of life. Nonetheless, totally implantable venous access devices are not free from complications. Among those, infection is the most relevant, affecting patients’ morbidity and mortality—both in the hospital or outpatient setting—and increasing healthcare costs. Knowledge of pathogenesis and risk factors of totally implantable venous access device–related infections is crucial to prevent this condition by adopting proper insertion bundles and maintenance bundles based on the best available evidence. Early diagnosis and prompt treatment of infection are of paramount importance. As a totally implantable venous access device–related infection occurs, device removal or a conservative approach should be chosen in treating this complication. For both prevention and therapy, antimicrobial lock is a major matter of controversy and a promising field for future clinical studies. This article reviews current evidences in terms of epidemiology, pathogenesis and risk factors, diagnosis, prevention, and treatment of totally implantable venous access device–related infections.

Acute kidney injury following coronary angiography: a nationwide study of incidence, risk factors and long-term outcomes

2018 ◽  
Vol 31 (5) ◽  
pp. 721-730 ◽  
Author(s):  
Dadi Helgason ◽  
Thorir E. Long ◽  
Solveig Helgadottir ◽  
Runolfur Palsson ◽  
Gisli H. Sigurdsson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Kidney Injury ◽  
Long Term Outcomes ◽  
Nationwide Study ◽  
Incidence Risk

scholarly journals Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study

2020 ◽  
Vol 9 (8) ◽  
pp. 2455 ◽  
Author(s):  
Tsai-Jung Wang ◽  
Ching-Heng Lin ◽  
Hao-Ji Wei ◽  
Ming-Ju Wu
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Heart Transplantation ◽  
Renal Dysfunction ◽  
Heart Transplant ◽  
Kidney Injury ◽  
Dialysis Patients ◽  
Term Survival

Acute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term survival and risk factors of dialysis were investigated. Patients who had undergone dialysis were stratified to early or late dialysis for subgroup analysis. The mean follow-up was five years, the incidence of dialysis was 28.4% (21% early dialysis and 7.4% late dialysis). The dialysis cohort had higher overall mortality compared with the non-dialysis cohort. The hazard ratios of mortality in patients with dialysis were 3.44 (95% confidence interval (CI), 2.73–4.33) for all dialysis patients, 3.58 (95% CI, 2.74–4.67) for early dialysis patients, and 3.27 (95% CI, 2.44–4.36; all p < 0.001) for late dialysis patients. Patients with diabetes mellitus, chronic kidney disease, acute kidney injury, and coronary artery disease were at higher risk of renal failure requiring dialysis. Cardiomyopathy, hepatitis B virus infection, and hyperlipidemia treated with statins were associated with a lower risk of renal dysfunction requiring early dialysis. The use of Sirolimus and Mycophenolate mofetil was associated with a lower incidence of late dialysis. Renal dysfunction requiring dialysis after heart transplantation is common in Taiwan. Early and late dialysis were both associated with an increased risk of mortality in heart transplant recipients.

scholarly journals One-Day Antibiotic Infusion for the Prevention of Postoperative Infection Following Arthroplasty: A Case Control Study

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Rui Niimi ◽  
Masahiro Hasegawa ◽  
Goshin Kawamura ◽  
Akihiro Sudo
Keyword(s):  
Postoperative Infection ◽  
Wound Infection Rate ◽  
Antibiotic Administration ◽  
Intravenous Antibiotic ◽  
Intravenous Antibiotics ◽  
Group A ◽  
Group B ◽  
To Receive ◽  
Antibiotic Infusion

Intravenous antibiotics effectively reduce the prevalence of postoperative infection. However, Japanese orthopaedic surgeons have no consensus with regard to the optimal duration of prophylaxis. The aim of this study is to compare the outcome of one-day intravenous antibiotic administration with that of long-term intravenous antibiotic administration. Patients who underwent total hip or knee arthroplasty were divided into 2 groups to receive one of 2 prophylactic protocols retrospectively. Group A (223 patients) received intravenous antibiotics twice only on the day of surgery, whereas Group B (104 patients) received intravenous antibiotics for at least 3 days after surgery. We analyzed the wound infection rate and monitored liver and renal functions. None of these patients had a postoperative infection. No liver dysfunction and renal dysfunction were observed. One-day antibiotic infusion was as effective as long-term antibiotics in preventing infection after arthroplasty and achieved greater cost effectiveness.

Sign in / Sign up

Export Citation Format

Share Document