Risk factors for acute kidney injury in critically ill patients with bacteraemia by carbapenem non-susceptible Gram negative bacteria

Infez Med. 2019 Dec 1;27(4):380-392.

Abstract

The objectives of the present study were to identify risk factors for development of acute kidney injury (AKI) during the treatment of bacteraemia due to carbapenem non-susceptible Gram-negative bacteria (CnS-GNB) and its role on mortality. Data of all patients with bacteraemia by CnS-GNB in the intensive care unit of a tertiary hospital from 2012 to 2016 were included. AKI was defined by AKIN criteria. Secondary outcomes were AKI development in patients treated with colistin and predictors of 14-day mortality. Among 285 episodes of bacteraemia due to CnS-GNB, 84 (29.5%) developed AKI. Multivariate analysis revealed that obesity, septic shock, maximum noradrenaline dose and eGFR<60 mL/min/1.73m² upon bacteraemia onset were independently associated with development of AKI. Out of 228 patients receiving colistin, 64 (28.1%) developed AKI. Multivariate analysis found the same factors as before in addition to voriconazole administration. Fourteen-day mortality was 34.2% and was independently associated with bacteraemia by Pseudomonas aeruginosa, AKI during bacteraemia treatment, maximum noradrenaline dose, SAPS II and SOFA scores upon bacteraemia onset, whereas appropriate combination therapy and catheter-related bacteraemia were independently associated with better survival. AKI was a frequent complication of bacteraemia by CnS-GNB and was associated with septic shock and baseline renal function impairment. Mortality was higher among patients that developed AKI due to bacteraemia. Colistin should be considered a safe therapeutic option for treating such infections.

MeSH terms

  • Acute Kidney Injury / epidemiology*
  • Acute Kidney Injury / etiology*
  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / complications*
  • Bacteremia / drug therapy*
  • Carbapenems / pharmacology*
  • Carbapenems / therapeutic use
  • Colistin / therapeutic use*
  • Critical Illness
  • Drug Resistance, Bacterial
  • Female
  • Gram-Negative Bacteria / drug effects*
  • Gram-Negative Bacterial Infections / complications*
  • Gram-Negative Bacterial Infections / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors

Substances

  • Anti-Bacterial Agents
  • Carbapenems
  • Colistin