Abstract
Limited literature is available assessing nephrotoxicity with prolonged β-lactam infusions. This study compared the incidence of acute kidney injury (AKI) associated with a prolonged β-lactam infusion or an intermittent infusion. This was a retrospective, matched-cohort study at an academic medical center from July 2006 to September 2015. Adult patients who received piperacillin-tazobactam (TZP), cefepime (FEP), or meropenem (MEM) for at least 48 h were evaluated. Patients were excluded for preexisting renal dysfunction or pregnancy. The primary outcome was difference in incidence of AKI evaluated using the RIFLE (risk, injury, failure, loss, and end-stage) criteria. Patients in the intermittent group were matched 3:1 to patients in the prolonged-infusion group based on the following: β-lactam agent, age, gender, Charlson comorbidity index, baseline creatinine clearance, hypotension, receipt of vancomycin, and treatment in an intensive care unit. A total of 2,390 patients were included in the matched analysis, with 1,700 receiving intermittent infusions and 690 receiving prolonged infusion. The incidence of AKI was similar in the prolonged-infusion group to that in the intermittent-infusion group (21.6% versus 18.6%; P = 0.1). After multivariate regression, prolonged infusion was not associated with increased odds of AKI (odds ratio [OR], 1.07; 95% confidence interval [95% CI], 0.83 to 1.39). Independent predictors of AKI included TZP therapy, concomitant nephrotoxins, hypotension, and heart failure. Although AKIs were numerically more common in patients receiving prolonged β-lactam infusions than those receiving intermittent infusions, prolonged infusion was not an independent risk factor for AKI.
Document Type
Article
Publication Date
10-2017
Digital Object Identifier (DOI)
https://doi.org/10.1128/AAC.00871-17
Funding Information
This project was supported by the NIH National Center for Advancing Translational Sciences through grant no. UL1TR001998.
Repository Citation
Cotner, Sarah E.; Rutter, Wilbur Cliff; Burgess, Donna R.; Wallace, Katie L.; Martin, Craig A.; and Burgess, David S., "Influence of β-Lactam Infusion Strategy on Acute Kidney Injury" (2017). Pharmacy Practice and Science Faculty Publications. 37.
https://uknowledge.uky.edu/pps_facpub/37
Notes/Citation Information
Published in Antimicrobial Agents and Chemotherapy, v. 61, issue 10, e00871-17, p. 1-7.
Copyright © 2017 American Society for Microbiology. All Rights Reserved.
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