DOI: 10.1128/AAC.02089-16
Article Figures & Data
Figures
- FIG 1
Patient selection diagram. CLCR, creatinine clearance; FEP, cefepime; OSH, outside hospital; TZP, piperacillin-tazobactam; VAN, vancomycin.
Tables
- TABLE 1
Patient demographic and clinical characteristicsa
Characteristic Unmatched cohort Matched cohort TZP-VAN (n = 3,605) FEP-VAN (n = 588) P value TZP-VAN (n = 1,633) FEP-VAN (n = 578) P value Mean ± SD age (yr) 51.5 ± 16.0 49.4 ± 17.0 0.006 49.7 ± 15.7 49.4 ± 17 0.7 No. (%) of male patients 2,177 (60.4) 326 (55.4) 0.03 905 (55.4) 323 (55.9) 0.9 Median (IQR) CCI 3 (1–6) 3 (1–5) 0.2 3 (1–5) 3 (1–5) 1 Median (IQR) baseline CLCR (ml/min) 97 (74–125) 101 (77–132) 0.01 100 (77–126) 101 (77–132) 0.4 No. (%) of patients with: Hypotension 946 (26.2) 190 (32.3) 0.002 479 (29.3) 186 (32.2) 0.2 Dehydration 220 (6.1) 36 (6.1) 1 98 (6.0) 34 (5.9) 1 Nephrotoxic drug exposure 2,190 (60.7) 349 (59.4) 0.5 939 (57.5) 340 (58.8) 0.6 ACEI/ARB 841 (23.3) 139 (23.6) 0.9 370 (22.7) 135 (23.4) 0.8 No. (%) of patients treated with or exposed to: Acyclovir 70 (1.9) 33 (5.6) <0.0001 28 (1.7) 29 (5.0) <0.0001 An aminoglycoside 473 (13.1) 101 (17.2) 0.01 209 (12.8) 98 (17.0) 0.02 Amphotericin B 63 (1.7) 16 (2.7) 0.1 27 (1.7) 15 (2.6) 0.2 A calcineurin inhibitor 114 (3.2) 19 (3.2) 1 35 (2.1) 19 (3.3) 0.2 Contrast dye 1,632 (45.3) 343 (58.3) <0.0001 921 (56.4) 336 (58.1) 0.5 Foscarnet 9 (0.2) 1 (0.2) 1 3 (0.2) 1 (0.2) 1 A loop diuretic 1,121 (31.1) 166 (28.2) 0.2 496 (30.4) 160 (27.7) 0.2 An NSAID 547 (15.2) 88 (15.0) 0.9 242 (14.8) 83 (14.4) 0.8 Sulfonamide 66 (1.8) 9 (1.5) 0.7 27 (1.7) 9 (1.6) 1 Tenofovir 21 (0.6) 4 (0.7) 0.8 8 (0.5) 4 (0.7) 0.5 No. (%) of patients with the following no. of risk factors: 0.0003 0.3 0 1,132 (31.4) 177 (30.1) 531 (32.5) 177 (30.6) 1 1,163 (32.3) 190 (32.3) 528 (32.3) 187 (32.4) 2 795 (22.1) 113 (19.2) 335 (20.5) 113 (19.6) 3 379 (10.5) 62 (10.5) 160 (10.4) 60 (10.4) ≥4 136 (3.8) 46 (7.8) 79 (7.1) 41 (7.1) Median (IQR) VAN dose (mg/day) 2,000 (1,500–2,500) 2,083 (1,600–2,737) <0.0001 2,000 (1,500–2,500) 2,083 (1,600–2,700) 0.002 No. (%) of patients with a daily VAN dose of ≥4,000 mg 39 (1.1) 16 (2.7) 0.002 18 (1.1) 16 (2.8) 0.009 No. (%) of patients with the following maximum VAN trough concn (μg/ml): 0.3 0.7 <10 438 (20.8) 77 (21.1) 213 (21.8) 76 (21.1) 10–15 507 (24.1) 100 (27.4) 231 (23.7) 98 (27.2) 15–20 521 (24.8) 88 (24.1) 239 (24.9) 87 (24.2) >20 639 (30.4) 100 (27.4) 293 (30.0) 99 (27.5) No. of days of antibiotic therapyc Total 5 (4–8) 5 (4–8) 0.05 5 (4–8) 5 (4–8) 0.4 Combination therapy 3 (3–5) 4 (3–6) 0.001 4 (3–5) 4 (3–6) 0.008 FEP or TZP therapy 5 (3–7) 5 (3–7) 0.8 5 (3–7) 5 (3–7) 0.2 VAN therapy 4 (3–6) 4 (3–7) <0.0001 4 (3–6) 4 (3–7) <0.0001 ↵a ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CCI, Charlson comorbidity index; CLCR, creatinine clearance; FEP, cefepime; IQR, interquartile range; NSAID, nonsteroidal anti-inflammatory drug; TZP, piperacillin-tazobactam; VAN, vancomycin.
- TABLE 2
Incidence of AKI in unmatched and matched cohortsa
Outcome Unmatched cohort Matched cohort No. (%) of patients P value No. (%) of patients P value VAN-TZP (n = 3,605) VAN-FEP (n = 588) VAN-TZP (n = 1,633) VAN-FEP (n = 578) Any AKI 771 (21.4) 74 (12.6) <0.0001 349 (21.4) 72 (12.5) <0.0001 Risk 422 (11.7) 44 (7.5) 0.003 179 (11.0) 42 (7.3) 0.01 Injury 244 (6.8) 21 (3.6) 0.004 113 (6.9) 21 (3.6) 0.006 Failure 105 (2.9) 9 (1.5) 0.08 57 (3.5) 9 (1.6) 0.03 ↵a FEP, cefepime; TZP, piperacillin-tazobactam; VAN, vancomycin.
- TABLE 3
Multivariate regression results in matched cohorta
Covariate and treatment group Adjusted odds ratio CI P value TZP-VAN Reference Reference Reference FEP-VAN 2.18 1.64–2.94 <0.001 VAN dose (mg/day) <1,000 0.53 0.16–1.39 0.3 1,000–1,499 1.01 0.72–1.42 0.9 1,500–1,999 Reference Reference Reference 2,000–2,499 1.08 0.79–1.48 0.6 2,500–2,999 1.16 0.81–1.65 0.4 3,000–3,999 1.61 1.11–2.32 0.01 ≥4,000 1.3 0.5–3.05 0.6 Duration of VAN therapy of ≥7 days 1.47 1.14–1.89 0.003 Acyclovir exposure 2.22 1.17–4.07 0.01 Amphotericin B exposure 2.25 1.14–4.41 0.02 Loop diuretic exposure 2.78 2.22–3.50 <0.001 Calcineurin inhibitor exposure 1.62 0.85–2.98 0.1 Dehydration exposure 1.81 1.18–2.72 0.005 ↵a FEP, cefepime; TZP, piperacillin-tazobactam; VAN, vancomycin.
- TABLE 4
Secondary endpointsa
Characteristic Unmatched cohort Matched cohort VAN-TZP (n = 3,605) VAN-FEP (n = 588) P value VAN-TZP (n = 1,633) VAN-FEP (n = 578) P value Median (IQR) time (days) to AKI 5 (3–9) 8 (4–16.8) 0.0006 5 (3–9) 8 (4–17) 0.0004 Median (IQR) hospital length of stay (days) 8 (4–15) 8 (4–17) 0.08 8 (4–15) 8 (5–17) 0.9 No. (%) of patients with in-hospital mortality 276 (7.7) 53 (9.0) 0.3 113 (6.9) 53 (9.2) 0.09 ↵a FEP, cefepime; IQR, interquartile range; TZP, piperacillin-tazobactam; VAN, vancomycin.
