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Acute Kidney Injury Risk in Patients Treated with Vancomycin Combined with Meropenem or Cefepime
Matthew S Sussman1, Michelle B Mulder1, Emily L Ryon1
1Divisions of Trauma, Burns, and Surgical Critical Care and Dewitt Daughtry Family Dept of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA.
Abstract:
No previous studies have determined the incidence of acute kidney injury (AKI) in trauma patients treated with vancomycin + meropenem (VM) versus vancomycin + cefepime (VC). The purpose of this study was to fill this gap. A series of 99 patients admitted to an American College of Surgeons-verified level 1 trauma center over a two-year period who received VC or VM for >48 hours were reviewed retrospectively. Exclusion criteria were existing renal dysfunction or on renal replacement therapy. The primary outcome was AKI as defined by a rise in serum creatinine (SCr) to 1.5 times baseline. Multi-variable analysis was performed to control for factors associated with AKI (age, obesity, gender, length of stay [LOS], nephrotoxic agent(s), and baseline SCr), with significance defined as p < 0.05. The study population was 50 ± 19 years old, 76% male, with a median LOS of 21 [range 15-39] days, and baseline SCr of 0.9 ± 0.2 mg/dL. Antibiotics, diabetes mellitus, and Injury Severity Score were independent predictors of AKI (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.4-12; OR 9.3; 95% CI 1-27; OR 1.2; 95% CI 1.023-1.985, respectively). The incidence of AKI was higher with VM than VC (10/26 [38%] versus 14/73 [19.1%]; p = 0.049). The renal toxicity of vancomycin is potentiated by meropenem relative to cefepime in trauma patients. We recommend caution when initiating vancomycin combination therapy, particularly with meropenem.
Insights
Acute kidney injury (AKI) incidence was higher in trauma patients receiving vancomycin + meropenem (VM) compared to vancomycin + cefepime (VC). This suggests meropenem potentiates vancomycin's renal toxicity in trauma care.
Area of Science:
- Nephrology
- Trauma Surgery
- Infectious Diseases
Background:
- Acute kidney injury (AKI) is a significant concern in trauma patients.
- The comparative incidence of AKI between vancomycin + meropenem (VM) and vancomycin + cefepime (VC) in trauma patients remains unstudied.
Purpose of the Study:
- To determine the incidence of AKI in trauma patients treated with VM versus VC.
- To identify risk factors associated with AKI in this patient population.
Main Methods:
- Retrospective review of 99 trauma patients receiving VM or VC for over 48 hours at a Level 1 trauma center.
- Exclusion of patients with pre-existing renal dysfunction or on renal replacement therapy.
- Multivariable analysis controlled for age, obesity, gender, length of stay, nephrotoxic agents, and baseline serum creatinine (SCr); AKI defined as SCr 1.5x baseline.
Main Results:
- The incidence of AKI was significantly higher in the VM group (38%) compared to the VC group (19.1%) (p=0.049).
- Independent predictors of AKI included antibiotic choice, diabetes mellitus, and Injury Severity Score.
- The study population comprised patients aged 50±19 years, 76% male, with a median length of stay of 21 days.
Conclusions:
- Meropenem potentiates the renal toxicity of vancomycin in trauma patients compared to cefepime.
- Caution is advised when initiating vancomycin combination therapy, especially with meropenem, in trauma patients.
- Further research may be warranted to elucidate the mechanisms behind this observed nephrotoxicity.
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