Risk of acute kidney injury associated with anti-pseudomonal and anti-MRSA antibiotic strategies in critically ill patients

• Published in: PloS one Vol. 17; no. 3; p. e0264281
• Main Authors: Côté, Jean-Maxime, Desjardins, Michaël, Cailhier, Jean-François, Murray, Patrick T, Beaubien Souligny, William
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10.03.2022; Public Library of Science (PLoS)
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - drug therapy; Acute Kidney Injury - epidemiology; Acute renal failure; Adult; Anti-Bacterial Agents - adverse effects; Antibiotics; Antimicrobial agents; Biology and Life Sciences; Blood; Clinical trials; Complications and side effects; Creatinine; Critical Illness; Drug dosages; Drug resistance; Drug Therapy, Combination; Ethnicity; Evaluation; Exposure; Female; Health care facilities; Health risks; Humans; Infectious diseases; Intensive care; Intensive care nursing; Kidneys; Leukopenia; Male; Medical care; Medicine and Health Sciences; Methicillin; Methicillin-Resistant Staphylococcus aureus; Multidrug resistant organisms; Nephrology; Patient outcomes; Patients; Piperacillin; Piperacillin-tazobactam; Pseudomonas; Quality management; Retrospective Studies; Risk; Risk factors; Sensitivity analysis; Staphylococcus aureus; Staphylococcus infections; Steroids; Tazobactam; Vancomycin; Vancomycin - adverse effects; Ventilators; Canada; Ireland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0264281

An increased risk of acute kidney injury (AKI) with the widely prescribed piperacillin-tazobactam(PTZ)-vancomycin combination in hospitalized patients has recently been reported, but evidence in ICU patients remain uncertain. This study evaluates the association between the exposure of various broad-spectrum antibiotic regimens with Pseudomonas and/or methicillin-resistance Staphylococcus aureus (MRSA) coverage and the risk of AKI in critically ill patients. A retrospective cohort study based on the publicly available MIMIC-III database reporting hospitalization data from ICU patients from a large academic medical center between 2001 and 2012. Adult patients receiving an anti-pseudomonal or an anti-MRSA agent in the ICU for more than 24-hours were included. Non-PTZ anti-pseudomonal agents were compared to PTZ; non-vancomycin agents covering MRSA were compared to vancomycin; and their combinations were compared to the PTZ-vancomycin combination. The primary outcome was defined as new or worsening AKI within 7 days of the antibiotic exposure using an adjusted binomial generalized estimating equation. Overall, 18 510 admissions from 15 673 individual patients, cumulating 169 966 days of antibiotherapy were included. When compared to PTZ, exposure to another anti-pseudomonal agent was associated with lower AKI risk (OR, 0.85; 95% CI, 0.80-0.91; p < .001). When compared to vancomycin, exposure to another anti-MRSA was also associated with lower AKI risk (OR, 0.71; 95% CI, 0.64-0.80; p < .001). Finally, when compared to the PTZ-vancomycin combination, exposure to another regimen with a similar coverage was associated with an even lower risk (OR, 0.63; 95% CI; 0.54-0.73; p < .001). A sensitivity analysis of patients with high illness severity showed similar results. These results suggest that the risk of AKI in ICU patients requiring antibiotherapy may be partially mitigated by the choice of antibiotics administered. Further clinical trials are required to confirm these findings.