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

Area of Science:

• Nephrology
• Critical Care Medicine
• Infectious Diseases

Background:

• Acute kidney injury (AKI) is a frequent complication during systemic infections like sepsis.
• Renal outcomes in sepsis patients, particularly those requiring renal replacement therapy (RRT), are not well understood.
• The rise of multidrug-resistant pathogens necessitates the use of potentially nephrotoxic antibiotics such as vancomycin.

Purpose of the Study:

• To investigate the impact of vancomycin and RRT on renal recovery in patients with severe sepsis or septic shock.
• To identify predictors of RRT need and prolonged RRT dependence at intensive care unit (ICU) discharge.

Main Methods:

• Retrospective data analysis of 1159 patients with severe sepsis or septic shock.
• Logistic regression models were employed to analyze the association between variables and RRT outcomes.
• Estimated glomerular filtration rate (eGFR) at admission was assessed as a predictor of RRT requirement and duration.

Main Results:

• 33.6% of patients required RRT during ICU stay, and 20.1% at discharge.
• Admission eGFR was a significant predictor for both the need for RRT during ICU stay and prolonged RRT at discharge.
• Vancomycin use (OR 1.648) and longer duration of treatment were associated with a higher probability of ongoing RRT at discharge.

Conclusions:

• Admission eGFR is a crucial predictor of renal outcome in sepsis patients.
• Vancomycin administration is linked to an increased likelihood of prolonged RRT dependence at ICU discharge.
• Consideration of alternative antibiotics for patients with impaired renal function at admission may improve renal recovery.