Downes KJ, et al. - This study incorporated an evaluation of the risk of acute kidney injury (AKI) in children during concomitant therapy with vancomycin and 1 antipseudomonal β-lactam antibiotic throughout the first week of hospitalization. It was deduced that such a coadministration could raise the risk of AKI in hospitalized children. Pediatricians were cautioned to be cognizant of the potential added risk of this combination therapy when making empirical antibiotic choices.

Methods

• This study recruited children hospitalized for 3 or more days who received IV vancomycin plus 1 other antipseudomonal β-lactam combination therapy.
• It was carried out at 1 of 6 large children’s hospitals from January 1, 2007, through December 31, 2012.
• It utilized the Pediatric Health Information System Plus database, encompassing the administrative and laboratory data from 6 pediatric hospitals in the United States.
• The exclusion criteria included patients with underlying kidney disease or abnormal serum creatinine levels on hospital days 0 to 2.
• The eligible candidates were patients 6 months to 18 years of age who were admitted through the emergency department of the hospital.
• Data were cumulated from July 2015 to March 2016.
• Data analysis was pursued from April 2016 through July 2017.
• The primary outcome consisted of AKI on hospital days 3 to 7 and within 2 days of receiving combination therapy.
• Acute kidney injury was defined using KDIGO criteria and was based on changes in serum creatinine level from hospital days 0 to 2 through hospital days 3 to 7.
• Multiple logistic regression via a discrete-time failure model inspected the link between AKI and receipt of IV vancomycin plus piperacillin/tazobactam or vancomycin plus 1 other antipseudomonal β-lactam antibiotic.

Results

• 1915 hospitalized children were enrolled, who received combination therapy.
• Among the 1915 patients, 866 (45.2%) were female and 1049 (54.8%) were male, 1049 (54.8%) were identified as white in race/ethnicity, and the median (interquartile range) age was 56 (2.1-12.7) years.
• 157 patients (8.2%) reported antibiotic-associated AKI, among those who received IV vancomycin plus 1 other antipseudomonal β-lactam antibiotic.
• It included 117 of 1009 patients (11.7%) who received IV vancomycin plus piperacillin/tazobactam combination therapy.
• After adjustment for age, intensive care unit level of care, receipt of nephrotoxins, and hospital, IV vancomycin plus piperacillin/tazobactam combination therapy illustrated a connection with higher odds of AKI each hospital day compared with vancomycin plus 1 other antipseudomonal β-lactam antibiotic combination (adjusted odds ratio, 3.40; 95% CI, 2.26-5.14).