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Antibiotic-Associated Acute Kidney Injury Among Older Adults: A Case-Crossover Study
Tichawona Chinzowu1, Te-Yuan Chyou2, Prasad S Nishtala3,4
1Department of Life Sciences, University of Bath, Bath, BA2 7AY, UK. tc888@bath.ac.uk.
Clinical Drug Investigation
|January 3, 2024
Summary
Certain antibiotics, like sulfamethoxazole/trimethoprim and fluoroquinolones, significantly increase the risk of acute kidney injury (AKI) in older adults. This highlights the need for careful prescribing of these common medications in this population.
Area of Science:
- Geriatric Medicine
- Pharmacology
- Nephrology
Background:
- Drug-related acute kidney injury (AKI) is a prevalent concern in the elderly population.
- Antibiotics are frequently co-prescribed with other medications in older adults.
- Identifying specific antibiotic risks is crucial for patient safety.
Purpose of the Study:
- To investigate the association between antibiotic use and incident acute kidney injury (AKI) in individuals aged 65 years and older in New Zealand.
- To quantify the risk of AKI associated with specific antibiotic classes in the elderly.
Main Methods:
- A case-crossover study design was employed using the New Zealand National Minimum Data Set (2005-2020).
- Individuals aged 65+ with incident AKI (ICD-10 code N17.x) were identified.
- A 66-day study period (3-day case window, two 30-day washout periods) and conditional logistic regression were used to assess antibiotic exposure odds.
Main Results:
- A total of 2399 incident AKI cases were identified in older adults.
- Use of sulfamethoxazole/trimethoprim was associated with a 3.57-fold increased odds of AKI (95% CI 2.86-4.46).
- Fluoroquinolone use was linked to a 2.56-fold increased odds of AKI (95% CI 1.90-3.46).
Conclusions:
- Sulfamethoxazole/trimethoprim and fluoroquinolones are associated with an increased risk of AKI in older adults.
- Vigilant prescribing of these antibiotics in the elderly is essential.
- Further research may explore alternative antibiotic choices or monitoring strategies for high-risk patients.
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