scholarly journals Risk of Kidney Injury among Construction Workers Exposed to Heat Stress: A Longitudinal Study from Saudi Arabia

2020 ◽  
Vol 17 (11) ◽  
pp. 3775
Author(s):  
Mohammed Al-Bouwarthan ◽  
Margaret M. Quinn ◽  
David Kriebel ◽  
David H. Wegman
Keyword(s):  
Risk Factors ◽  
Saudi Arabia ◽  
Heat Stress ◽  
Linear Regression Analysis ◽  
Kidney Injury ◽  
Construction Workers ◽  
Multivariate Linear Regression Analysis ◽  
Summer Heat ◽  
Adequate Hydration ◽  
The Impact

Saudi Arabia (SA) is one of the hottest countries in the world. This study was conducted to assess the impact of summer heat stress in Southeastern SA on short-term kidney injury (KI) among building construction workers and to identify relevant risk factors. Measurements of urinary albumin-creatinine ratio (ACR), height, weight, hydration, symptoms, daily work and behavioral factors were collected in June and September of 2016 from a cohort of construction workers (n = 65) in Al-Ahsa Province, SA. KI was defined as ACR ≥ 30 mg/g. Multivariate linear regression analysis was used to assess factors related to cross-summer changes in ACR. A significant increase in ACR occurred among most workers over the study period; incidence of KI was 18%. Risk factors associated with an increased ACR included dehydration, short sleep, and obesity. The findings suggest that exposure to summer heat may lead to the development of KI among construction workers in this region. Adequate hydration and promotion of healthy habits among workers may help reduce the risk of KI. A reduction in work hours may be the most effective intervention because this action can reduce heat exposure and improve sleep quality.

A Field Evaluation of Construction Workers’ Activity, Hydration Status, and Heat Strain in the Extreme Summer Heat of Saudi Arabia

2020 ◽  
Vol 64 (5) ◽  
pp. 522-535 ◽  
Author(s):  
Mohammed Al-Bouwarthan ◽  
Margaret M Quinn ◽  
David Kriebel ◽  
David H Wegman
Keyword(s):  
Heart Rate ◽  
Saudi Arabia ◽  
Heat Stress ◽  
Heat Exposure ◽  
Heat Strain ◽  
Construction Workers ◽  
Hydration Status ◽  
Summer Heat ◽  
Cardiovascular Strain ◽  
Indoor And Outdoor

Abstract Objectives Assess the impact of summer heat exposure (June–September) on residential construction workers in Al-Ahsa, Saudi Arabia by evaluating (i) heart rate (HR) responses, hydration status, and physical workload among workers in indoor and outdoor construction settings, (ii) factors related to physiological responses to work in hot conditions, and (iii) how well wet-bulb globe temperature-based occupational exposure limits (WBGTOELs) predict measures of heat strain. Methods Twenty-three construction workers (plasterers, tilers, and laborers) contributed 260 person-days of monitoring. Workload energy expenditure, HR, fluid intake, and pre- and postshift urine specific gravity (USG) were measured. Indoor and outdoor heat exposures (WBGT) were measured continuously and a WBGTOEL was calculated. The effects of heat exposure and workload on heart rate reserve (HRR), a measure of cardiovascular strain, were examined with linear mixed models. A metric called ‘heat stress exceedance’ (HSE) was constructed to summarize whether the environmental heat exposure (WBGT) exceeded the heat stress exposure limit (WBGTOEL). The sensitivity and specificity of the HSE as a predictor of cardiovascular strain (HRR ≥30%) were determined. Results The WBGTOEL was exceeded frequently, on 63 person-days indoors (44%) and 91(78%) outdoors. High-risk HRR occurred on 26 and 36 person-days indoors and outdoors, respectively. The HSE metric showed higher sensitivity for HRR ≥30% outdoors (89%) than indoors (58%) and greater specificity indoors (59%) than outdoors (27%). Workload intensity was generally moderate, with light intensity work more common outdoors. The ability to self-pace work was associated with a lower frequency of HRR ≥30%. USG concentrations indicated that workers began and ended their shifts dehydrated (USG ≥1.020). Conclusions Construction work where WBGTOEL is commonly exceeded poses health risks. The ability of workers to self-pace may help reduce risks.

Impact of empirical antibiotic regimens on mortality in neutropenic patients with bloodstream infection presenting with septic shock

2021 ◽  
Author(s):  
Mariana Chumbita ◽  
Pedro Puerta-Alcalde ◽  
Carlota Gudiol ◽  
Nicole Garcia-Pouton ◽  
Júlia Laporte-Amargós ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Kidney Injury ◽  
Bloodstream Infections ◽  
Gram Positive ◽  
Gram Negative ◽  
Neutropenic Patients ◽  
Prospective Cohorts ◽  
Independent Risk Factors ◽  
The Impact

Objectives: We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. Methods: Multicenter retrospective study (2010-2019) of two prospective cohorts comparing BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Results: Of 1563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% vs 15%, p<0.001). Gram-negative bacilli caused 81% of episodes with septic shock; gram-positive cocci, 22%; and Candida species 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% vs 51%, p=0.002). Age >70 years (OR 2.3, 95% CI 1.2-4.7), IEAT for Candida spp. or gram-negative bacilli (OR 3.8, 1.3-11.1), acute kidney injury (OR 2.6, 1.4-4.9) and amikacin as the only active antibiotic (OR 15.2, 1.7-134.5) were independent risk factors for mortality, while combination of β-lactam and amikacin was protective (OR 0.32, 0.18-0.57). Conclusions: Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.

Abstract P284: The Association Of Oral Hypofunction And Increased Arterial Stiffness

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Chisa Matsumoto ◽  
Hirofumi Tomiyama ◽  
Mari Matsuura ◽  
Takayuki Nakai ◽  
Daichi Chikazu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Arterial Stiffness ◽  
Subgroup Analysis ◽  
Linear Regression Analysis ◽  
Tongue Pressure ◽  
Multivariate Linear Regression Analysis ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Swallowing Function ◽  
Cross Sectional

Background: Frailty is associated with higher risk of cardiovascular disease (CVD) and mortality. Recently, oral hypofunction, a disease in which the oral function is complexly reduced not only by ageing but also by a variety of factors, is regarded as a major risk factor for frailty, as it develops malnutrition and sarcopenia. However, no studies have evaluated the association of oral hypofunction and arterial stiffness, a marker for CVD. Hypothesis: We hypothesized that subjects with oral hypofunction have increased arterial stiffness compared to those without oral hypofunction. Methods: Japanese subjects above 50 years old who underwent annual health checkup were enrolled in this cross-sectional study. Subjects with history of CVD and dementia were excluded. Arterial stiffness was evaluated by brachial-ancle pulse wave velocity (baPWV). Oral hypofunction was evaluated based on the guidance by the Japanese Association for Dental Science. Seven oral factors, oral hygiene, oral moisture, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function were assessed. Oral hypofunction was diagnosed if more than 3 factors showed deterioration. The association of oral hypofunction and baPWV was evaluated by multivariate linear regression analysis adjusted for conventional CVD risk factors. We also performed subgroup analysis stratified by age. (<60, ≧60 years). Results: Among 148 subjects (mean age: 59±7 years), 34 subjects (23%) had oral hypofunction. BaPWV in subjects with oral hypofunction was significantly higher than subjects without oral hypofunction (mean baPWV: 1539±312 v.s. 1416±260cm/sec, p=0.02). However, after adjustment for CVD risk factors, oral hypofunction did not significantly associate with baPWV (β=46±49, p=0.35). On the other hand, in subgroup analysis, oral hypofunction was significantly associated with increased baPWV among subjects in subjects younger than 60 years old even after adjustment of CVD risk factors (β=135±67, p=0.046), but this association was not observed in subjects over 60s. Conclusion: Oral hypofunction was associated with increased arterial stiffness, especially in subjects younger than 60s. Further research on oral hypofunction and CVD is warranted.

Decreased Circulating Insulin-Like Growth Factor 1 Levels Are Associated with Cardiac Diastolic Dysfunction in Small for Gestational Age Infants

2018 ◽  
Vol 35 (12) ◽  
pp. 1178-1185
Author(s):  
Shoko Yamazaki ◽  
Haruka Obinata ◽  
Akira Hachiya ◽  
Motoko Kamiya ◽  
Noriko Motoki ◽  
...  
Keyword(s):  
Growth Factor ◽  
Diastolic Dysfunction ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Linear Regression Analysis ◽  
Entire Population ◽  
Doppler Imaging ◽  
Multivariate Linear Regression Analysis ◽  
Insulin Like Growth Factor ◽  
The Impact

Objective To evaluate the impact of serum insulin-like growth factor-1 (IGF-1) levels on cardiac function in small for gestational age (SGA) infants. Study Design This is a prospective, observational study. Serum IGF-1 levels at birth and echocardiography measurements at 1 week of age were compared between SGA and appropriate for gestational age (AGA) infants. Results Thirty-one SGA infants and 27 AGA infants were enrolled. Serum IGF-1 levels were lower in the SGA infants than in the AGA infants. SGA infants had lower mitral lateral annular systolic (S') and early diastolic (E') tissue Doppler imaging velocities compared with AGA infants (S', 5.1 ± 0.9 vs 5.7 ± 1.2 cm/s; E', 6.1 ± 1.5 cm/s vs 7.1 ± 1.3 cm/s; p < 0.05). Serum IGF-1 levels positively correlated with E' velocity in the entire population (r = 0.44, p < 0.001) and in SGA infants (r = 0.39, p < 0.05). In multivariate linear regression analysis, serum IGF-1 and S' velocity were independently associated with E' velocity in the entire population and in SGA infants. Conclusion Decreased serum IGF-I levels could account for cardiac diastolic dysfunction in SGA infants.

scholarly journals Factors Associated with Social Avoidance of Recovered COVID-19 Patients in Iran: A National Study

2021 ◽  
Author(s):  
Teamur Aghamolaei ◽  
Shokrollah Mohseni ◽  
Azin alavi ◽  
mohammed hossein chalak ◽  
Hesamaddin Kamalzadeh Takhti ◽  
...  
Keyword(s):  
Linear Regression Analysis ◽  
Education Level ◽  
National Study ◽  
Multivariate Linear Regression Analysis ◽  
Age Group ◽  
Social Avoidance ◽  
Cross Sectional ◽  
Factors Associated ◽  
Study Results ◽  
The Impact

Abstract Background: Misconceptions about the infection and health consequences of recovered Coronavirus Disease 2019 (COVID-19) patients often lead to a fear, social avoidance and discriminatory attitude. The present study explored the Factors associated with social avoidance and job-related discriminatory attitude against recovered COVID-19 patients. Methods: The present cross-sectional online study was conducted on 3,836 Iranian participants above 15 years old. The participant selected conveniently between February 19, 2021 and May 21, 2021. The data collected using a reliable and valid questionnaire that developed by research team. Univariate and multivariate linear regression analysis was used to identify the impact of factors related to social discrimination and discriminatory attitudes towards improved COVID-19 patients. Results: The results shows 56.72 and 49.06% of the population had social avoidance and job-related discriminatory attitude respectively. Furthermore, age, gender, education level, marital status, employment, presence of a recovered COVID-19 patient in family and place of residence were significant factors influencing social avoidance and job-related discriminatory attitude. As an instance, those in the 45-64 age group showed 1.1 times more social avoidance than the 20-29 age group. Also, men showed 37% less social avoidance than women. Social avoidance was significantly higher and the discriminatory attitude was higher in participants of lower education level. Besides, the job-related discriminatory attitude was 1.2 times higher in the 45-64 than the 20-29 age group. The discriminatory attitude was 16% less in men, 39%, 25% and 49% less, respectively in participants with a secondary school, diploma or university degree.Conclusions: To reduce social avoidance and job-related discriminatory attitude we suggest that the medical sector and relevant organizations provide clear and comprehensive information about improved COVID-19 patients to their families and general public through direct communication and the mass media. Base on the study results they need more focus on urban residents, women and families with a recovered member

scholarly journals PROGNOSTIC VALUE OF RENAL DYSFUNCTION AND THE IMBALANCE OF BODY AQUATIC ENVIRONMENTS IN PATIENTS WITH ACUTE CORONARY PATHOLOGY

2017 ◽  
Vol 21 (1) ◽  
pp. 39-45
Author(s):  
E. O. Golovinova ◽  
M. M. Batiushin ◽  
E. S. Levitskaya ◽  
A. V. Khripun
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Dysfunction ◽  
Myocardial Revascularization ◽  
Kidney Injury ◽  
Cardiovascular Complications ◽  
Aquatic Environments ◽  
Prognostic Impact ◽  
Late Period ◽  
The Impact

THE AIM. Assessment of the impact of renal dysfunction and imbalance of body aquatic environments distribution on the risk of developing cardiovascular complications in the late period after acute coronary syndrome (ACS) and myocardial revascularization. PATIENTS AND METHODS. We examined 120 patients with ACS undergoing myocardial revascularization. We estimated traditonal and renal risk factors (albuminuria 30-300 mg/l, the value of GFR, acute kidney injury development), and body aquatic environments factors. Upon completion of the primary material processing, to determine the effect of the studied risk factors, we selected combined endpoint of the study – development of arrhythmias or death of patients, which were registered 6 months after restoration of coronary blood flow. RESULTS. By results of the carried out research we established effect on the probability of cardiovascular complications (CVC) by such risk factors as the presence of albuminuria, and acute kidney injury (AKI). AKI episode in patients with ACS associated with increase of arrhythmias and death possibilities in late period. It is established that AKI coupled with an imbalance of body aquatic environments increases the CVC development possibility 6 months after percutaneous coronary intervention in patients with ACS. CONCLUSION. In patients with ACS and myocardial revascularization revealed prognostic impact of the AKI and failure of body aquatic environments at the risk of CVC. 

scholarly journals THE INCIDENCE AND RISK FACTORS OF CONTRAST INDUCED NEPHROPATHY IN PATIENTS UNDERGOING CORONARY ANGIOPLASTY.

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Mukesh Kumar Sharma ◽  
Pradeep Kurmi ◽  
Deepak Ameta ◽  
Chandra Bhanu Chandan
Keyword(s):  
Risk Factors ◽  
Contrast Media ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
Absolute Increase ◽  
Increased Risk ◽  
Adequate Hydration

Background: Contrast induced nephropathy remains important cause of hospital-acquired acute kidney injury and affects between 2% of the general population to 50% of high-risk subgroups following coronary intervention. Objectives: To determine the incidence and to study the various risk factors associated with CIN. Patients and Methods: In our study, total of 212 patients (154 males and 58 females) who received non ionic iso osmolar contrast media during percutaneous transluminal coronary intervention (PCI) were included. We diagnosed CIN by a relative increase of >25% or an absolute increase of >0.5 mg/dl in serum creatinine levels two days after procedure. Results: The incidence of CIN in our study was 15.1%. In univariate analysis: age >75 years, hypertention diabetes mellitus (DM), heart failure, hypotension, CKD [creatinine  >1.5mg/dl] and increased contrast volume were associated with increased  risk of CIN whereas,  gender, anemia and use of IABP failed to reach statistical significance. As the number of risk factor and/or volume of contrast increases, the incidence of CIN increases exponentially. Conclusion: Since there is no established treatment for CIN, all possible efforts should be taken to prevent it from occurring by identifying patients at risk. CIN is related with many risk factors, so whenever multiple risk factors are present in an individual patient, lowest dose of contrast should be used and adequate hydration should be given. Key Words: Contrast-induced nephropathy, Non ionic iso-osmolar contrast media, percutaneous coronary intervention.

scholarly journals 599 Gender-based differences in TAVI outcomes: report from a large contemporary real-world population of self-expandable valves

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alessandro Sticchi ◽  
Francesco Gallo ◽  
Vincenzo De Marzo ◽  
Kim Won-keun ◽  
Tobias Zeus ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Primary Endpoint ◽  
Major Bleeding ◽  
Real World ◽  
Vascular Complications ◽  
Kidney Injury ◽  
World Population ◽  
Gender Based ◽  
The Impact

Abstract Aims Small sub-study data derived from randomized clinical trials suggest a gender-based disparity in TAVI outcomes. However, large real-world contemporary data is missing. The aim of this study is to compare the risk factors, procedural characteristics and clinical outcomes of male and female patients who underwent transcatheter aortic valve implantation (TAVI) using two next-generation self-expandable bioprostheses (ACURATE neo and Evolut R/Pro valves). Methods We performed a first unmatched comparison and a propensity score-matched analysis (PSM) to assess the outcomes derived by the sex difference beyond the impact of pre-procedural risk factors in a large, contemporary, real-world, multicentre, international, retrospective registry of 3862 consecutive patients. The primary endpoint was a composite of all-cause death or any stroke (disabling and non-disabling) at 1 year. Results Sixty-four per cent (2162/3353 patients) of the study cohort was female and was older (mean age 82.3 years vs. 81.1 years for men (P&lt;0.001)) had a higher BMI (27.7±5.7 for women vs. 27.2±4.5 for men), and lower prevalence of dyslipidaemia (50.2% vs. 54.7, P=0.037), diabetes (26.8% vs. 33.7, P&lt;0.001), smoking (10.0% vs. 24.3%, P&lt;0.001), COPD (17.4% vs. 21.9%, P=0.002), pacemaker/ICD (9.6% vs. 14.0%, P&lt;0.001), previous cardiac surgery (8.6% vs. 18.8%, P&lt;0.001), previous PCI (23.0% vs. 36.8%, P&lt;0.001). Mean STS score for women was higher 5.2±3.9% vs. 4.5±3.4% (P&lt;0.001). Women had higher mean valve gradients (45.4±17.1 vs. 42.7±14.7 mmHg; P&lt;0.001), smaller valve areas (mean 0.7 cm2 vs. 0.9 cm2, P=0.037) and smaller annular perimeters (56.8±23.0 vs. 62.0±23.8, P&lt;0.001). The primary endpoint was resulted in a rate of 7.9% vs. 6.9% (P=0.337) in the unmatched population and 9.4% vs. 6.0% (P=0.014) after the PSM, respectively for women and for men. Independently, there was no difference in mortality (5.9% vs. 5.6%; P=0.786) and stroke (2.5% vs. 1.8%; P=0.243) rates between women and men in the un-matched groups. Rates of cardiac tamponade (1.5% vs. 0.4%, P=0.008), major vascular complications (7.7% vs. 4.1%, P&lt;0.001), life-threatening bleeding (2.8% vs. 1.4%, P=0.016), major bleeding (5.1% vs. 2.9%, P=0.004), need of transfusion (8.9% vs. 4.6%, P&lt;0.001) and acute kidney injury (8.5% vs. 5.7%, P=0.009), were all significantly higher in women. After PSM, mortality was similar between the two groups (11.3% for women vs. 9.5% for men, P=0.264) but strokes were more prevalent in women (2.8% vs. 1.2%, P&lt;0.024). Furthermore, in the matched population, major vascular complications (6.8% vs. 4.1%, P=0.024), need of transfusion (9.1% vs. 4.6%, P&lt;0.001) and acute kidney injury (8.7% vs. 5.6%, P=0.009) remained significantly different between women and men, respectively. Conclusions In this large real-world contemporary TAVI registry, female gender was associated with higher rates of stroke, vascular complications, major bleeding, and acute kidney injury. Further studies are required to explore the underlying pathophysiological mechanisms for these observations.

scholarly journals The Impact of Anti-Microbial Drug-Drug Interactions on Acute Kidney Injury after Allogeneic Hematopoietic Cell Transplantation

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 29-30
Author(s):  
Fumiya Wada ◽  
Yasuyuki Arai ◽  
Junya Kanda ◽  
Toshio Kitawaki ◽  
Masakatsu Hishizawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Drug Interactions ◽  
Antimicrobial Agents ◽  
Hematopoietic Cell Transplantation ◽  
Kidney Injury ◽  
Time Dependent ◽  
Post Transplant ◽  
Increased Risk ◽  
The Impact

Introduction: Acute kidney injury (AKI) is one of the major complications after allogeneic hematopoietic cell transplantation (allo-HCT), and several studies have demonstrated a relationship between poor outcome and the concomitant AKI in the early phase after allo-HCT. Among various post-transplant factors, usage of antimicrobial agents, especially in cases where multiple agents are combined, may be one of the major causes of post-transplant AKI, due the potential nephrotoxicity of each agent and drug-drug interactions. An association between the combination of vancomycin (VCM) with piperacillin/tazobactam (PIPC/TAZ) and increased risk of developing AKI after allo-HCT has been reported; however, no reports have demonstrated the impact of other combinations on post-transplant AKI. Herein, we performed a retrospective analysis to compare the incidence of AKI according to selected antimicrobial agents, using a database with information covering the time-dependent administrative status of all the agents involved. Methods: We included patients with hematological malignancies who received allo-HCT between 2006 and 2018 in Kyoto University, Kyoto, Japan to evaluate the incidence and risk factors of AKI early after transplantation (before Day100). The incidence of AKI was defined according to Acute Kidney Injury Network (AKIN) classification and evaluated, considering early death as a competing risk. Administrative status of each antimicrobial agent was treated as a time-dependent covariate, and the synergetic effects on AKI by multiple agents in combination were evaluated as p for interaction. Results: In total, 465 transplant cases (416 patients) were included. The median age at HCT was 49 years old (range, 17-70). Among these, 104 cases received a related-donor transplant (64 patients received bone marrow and 40 peripheral-blood stem cell grafts), 207 received a transplant from unrelated donors, and 154 received a single-unit cord-blood transplant. The median value for pre-transplant serum creatinine (sCr) was 0.6 (range, 0.20-1.68). The cumulative incidence of AKI at Day100 was 40.0%, and overall survival (OS) at 3 years after HCT was 43.5% in patients with AKI while 70.9% in those without AKI (hazard ratio [HR] = 2.63, 95% confidence interval = 1.95-3.55, p &lt; 0.01). Being male and having a higher pre-transplant sCr were significant risk factors for AKI (HR = 1.53, p &lt; 0.01 and HR = 4.21, p &lt; 0.01, respectively). After HCT, 34 types of oral or intravenous antimicrobial agents (17 antibiotics, 6 antivirals, and 11 antifungals) were utilized across the entire cohort. A higher incidence of AKI was significantly associated with the use of intravenous ciprofloxacin, foscarnet (FCN), ganciclovir (GCV), liposomal amphotericin B (L-AMB), meropenem (MEPM), PIPC/TAZ, and VCM (p &lt; 0.05). Next, we investigated the synergistic impacts of using anti-pseudomonal antibiotics and anti-methicillin resistant staphylococcus aureus (MRSA) agents, because empiric treatment of febrile neutropenia after HCT often relies on this combination, i.e. CFPM, PIPC/TAZ, or MEPM in combination with VCM or teicoplanin (TEIC). As a result, sole administration of VCM was associated with a higher incidence of AKI; this effect was enhanced when VCM was used in combination with PIPC/TAZ (HR = 3.03, p &lt; 0.01 for VCM without PIPC/TAZ; HR = 4.38, p &lt; 0.01 for VCM with PIPC/TAZ), indicating the existence of interaction between VCM and PIPC/TAZ. However, for the concomitant use of VCM plus CFPM or MEPM, no synergistic interaction was observed with regard to the increased incidence of AKI. In addition, administration of TEIC alone and any combination used with TEIC were not associated with an increased risk of AKI. An increased risk of AKI was also confirmed for the combination of MEPM plus GCV or FCN, and GCV plus L-AMB. Conclusions: AKI was significantly associated with poorer OS, and specific antimicrobial combinations were suggested to increase the risk of AKI. Avoidance of such combinations should be considered to preserve renal function and to reduce AKI-related morbidity and mortality. Disclosures No relevant conflicts of interest to declare.

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