Hidayat L, Hsu D, Quist R, et al. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infection: efficacy and toxicity. Arch Intern Med 2006; 166:2138-2144.
Liu C, Bayer A, Cosgrove S, et al. Clinical practice guidelines by the infectious Disease Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and
Need for study
6
RIFLE
RIFLE criteria
11
Primary outcome:
Incidence of AKI, defined as a minimum 1.5-fold increase
from the patient’s baseline serum creatinine
Secondary outcome:
Percentage of patients who developed AKI and met any of
the following criteria:
use of concomitant nephrotoxic agents
advanced age
steady-state vancomycin trough concentration of ≥15 mCg/mL
total vancomycin dose of ≥4 gm/day
Data collection
13
Demographi Age, Gender, Ethnicity, Height, Weight, Body mass index (BMI)
cs
Labs Blood urea nitrogen (BUN), Baseline serum creatinine (SCr)
Conditions Evidence of systemic inflammatory response syndrome (SIRS),
Hypotension, Indication of antibiotic
Concurrent Acyclovir
medications Aminoglycosides
Angiotensin converting enzyme inhibitors (ACEi)
Angiotensin receptor blockers (ARBs)
Calcineurin inhibitors
IV contrast
Loop diuretics
Non-steroidal anti-inflammatory drugs (NSAIDs)
Sulfonamides
Tenofovir
Baseline characteristics
14
0.063
50
45
40
35
30
25 0.501
20 0.162
15
10
5 0.066
0 With Vancomycin
2846 2430 3018 18 6
Without Vancomycin
Results
17
Correction Variable P-
value
Stages 0.009
Retrospective study
Duration of use for antimicrobials and
other concomitant nephrotoxins was not
collected
Urine output was not consistently
documented
Study was not adequately powered
Conclusion
20
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Risk of Developing Acute Kidney Injury with the Combination of
Vancomycin and Piperacillin-tazobactam versus
Piperacillin-tazobactam Alone