Renal outcome after vancomycin treatment and renal replacement therapy in patients with severe sepsis and septic shock: A retrospective study

• Published in: Journal of critical care 2014-08, Vol.29 (4), p.656-661
• Main Authors: Otto, Gordon P., MD, MSc, Sossdorf, Maik, PhD, Breuel, Hannes, MD, Schlattmann, Peter, MD, MSc, Bayer, Ole, MD, Claus, Ralf A., PhD, Riedemann, Niels C., MD, Busch, Martin, MD
• Format: Article
• Language: English
• Subjects: Acute kidney injury; Acute Kidney Injury - therapy; Aged; Anti-Bacterial Agents - adverse effects; Antibiotics; APACHE; Confidence intervals; Critical Care; Diabetes; Female; Glomerular Filtration Rate - physiology; Humans; Hypertension; Intensive Care Units; Kidney diseases; Length of Stay; Logistic Models; Male; Middle Aged; Mortality; Patients; Plasma; Renal outcome; Renal replacement therapy; Renal Replacement Therapy - statistics & numerical data; Retrospective Studies; Sepsis; Sepsis - drug therapy; Sex Factors; Shock, Septic - drug therapy; Staphylococcus infections; Studies; Vancomycin; Vancomycin - adverse effects
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.03.015

Abstract Purpose Acute kidney injury during systemic infections is common; however, renal outcome is poorly investigated. The increase of multiresistant pathogens leads to the use of potential nephrotoxic antibiotics as vancomycin. We investigated the impact of vancomycin and renal replacement therapy (RRT) for renal recovery during sepsis. Materials and methods This is a retrospective data analysis of 1159 patients with severe sepsis or septic shock. Logistic regression models were performed. Results In total, 390 (33.6%) patients required RRT during intensive care unit (ICU) stay; 233 (20.1%), at discharge. Admission estimated glomerular filtration rate (eGFR) predicted the need of RRT during stay (odds ratio [OR] 0.969 [0.959-0.979] per increase of 1 mL/min, P < .001) and the prolonged need of RRT at ICU discharge (OR 0.979 [0.967-0.990], P < .001). Survivors without any RRT showed an improvement of eGFR at discharge, whereas patients after RRT did not (7.1 vs 0.8 mL/[min 1.73 m2 ], P < .001). The use (OR 1.648 [1.067-2.546], P < .05) and duration of vancomycin treatment (OR 1.043 [1.004-1.084] per each additional treatment day, P < .05) were predictors for ongoing RRT at discharge. Conclusions Estimated GFR at ICU admission predicts renal outcome, whereas the use of vancomycin increases the probability of a prolonged need for RRT at discharge from ICU. The use of alternative antibiotics for certain patients, indicated by eGFR at admission, might be considered.