Madison Gray, PharmD
PGY2 Critical Care Pharmacy Resident
University of Mississippi Medical Center
Jackson, MS
Disclosure information not submitted.
Tessa Wiley, PharmD, BCCCP
Clinical Pharmacist
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Katherine Artman, PharmD, BCCCP
Clinical Pharmacist
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Alan Dukes, PharmD, BCCCP
Clinical Pharmacist
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Title: Incidence of Renal Replacement Therapy in Critically Ill Patients Receiving Combination Antibiotics
Introduction/Hypothesis: Broad spectrum antibiotic therapy in hospitalized patients with unknown source of infection frequently includes vancomycin with either piperacillin-tazobactam or cefepime. Recent evidence demonstrates increased rates of acute kidney injury (AKI) in patients receiving both vancomycin and piperacillin-tazobactam (VPT). However, rates of renal replacement therapy (RRT) have not routinely been reported, and critically ill patients have been underrepresented despite their increased risk of developing an AKI. The purpose of this study was to compare the incidence of RRT between VPT and vancomycin plus cefepime (VC) in surgical intensive care unit (SICU) patients.
Methods: This was a single-center, retrospective, cohort study of SICU patients who received either VPT or VC. The primary outcome of this study was incidence of RRT, and the secondary outcomes included time to RRT, duration of RRT, and incidence of AKI. Other data points collected included serum creatinine, duration of antibiotic therapy, and type of RRT.
Results: Fifty patients were included in the study with 25 patients in each group. Baseline serum creatinine was similar between groups (VPT: 0.77 [0.6-1.12] mg/dL vs. VC: 0.81 [0.64-0.81] mg/dL). Duration of combination antibiotic therapy was 4 [3-5] days in the VPT group and 3 [3-4] days in the VC group. Incidence of RRT was similar between groups (VPT: 1 vs. VC: 2; p=1.00), and each patient requiring new RRT received continuous renal replacement therapy. Incidence of AKI was also similar between groups (VPT: 4 vs. VC: 7; p=0.496). Duration of RRT was longer for the VPT patient (VPT: 15 days vs. VC: 6.5 days). One patient in each group required RRT during combination antibiotic therapy with similar time to RRT from antibiotic initiation (VPT: 2 days vs. VC: 3 days). One patient in the VC group received RRT > 72 hours after the discontinuation of antibiotic therapy.
Conclusions: Incidence of RRT did not differ in patients who received VPT compared to VC. Time to RRT, duration of RRT, and incidence of AKI were also similar between groups.