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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Mitigating Risk of Acute Kidney Injury Among Children With Methicillin-resistant Staphylococcus aureus Osteomyelitis
Lasya Challa1, Mary C Villani2, Ahmad A Hachem3
1Division of Pediatric Hospital Medicine, University of Texas Southwestern.
Insights
Vancomycin treatment for pediatric methicillin-resistant Staphylococcus aureus osteomyelitis increases acute kidney injury (AKI) risk. This elevates healthcare costs and resource use, suggesting optimized vancomycin dosing and alternative antibiotics are needed.
Area of Science:
- Pediatric infectious diseases
- Nephrology
- Pharmacology
Background:
- Vancomycin is a primary treatment for pediatric methicillin-resistant Staphylococcus aureus acute hematogenous osteomyelitis (MRSA AHO).
- Vancomycin use is associated with a risk of acute kidney injury (AKI).
Purpose of the Study:
- To evaluate the incidence of AKI in children with MRSA AHO treated with vancomycin.
- To compare resource utilization and healthcare costs between children with and without AKI.
Main Methods:
- Retrospective study of children with MRSA AHO treated with vancomycin.
- AKI assessment using clinical diagnosis and Kidney Disease Improving Global Outcomes (KDIGO) criteria.
- Multivariate logistic regression and cost analysis using healthcare databases.
Main Results:
- AKI incidence was 16.5% by chart diagnosis and 28.2% by KDIGO criteria.
- Children with AKI experienced longer hospitalizations, more febrile days, and higher thrombosis rates.
- Higher vancomycin trough levels (≥21.7 mg/L) and longer treatment duration were associated with AKI.
- AKI significantly increased length of stay and healthcare charges.
Conclusions:
- Clinical documentation of AKI underestimates its true occurrence in pediatric MRSA AHO.
- Vancomycin-associated AKI leads to increased resource utilization and healthcare costs.
- Strategies to reduce AKI risk include optimizing vancomycin trough levels, shortening treatment duration, and considering alternative antibiotics for specific MRSA strains.
Objective:
Children with acute hematogenous osteomyelitis (AHO) from methicillin-resistant Staphylococcus aureus (MRSA) are treated with vancomycin despite the risk of acute kidney injury (AKI). This study evaluates the rate of AKI and resource utilization for children with or without AKI when vancomycin is used in this setting.
Methods:
Children with MRSA AHO treated with vancomycin were retrospectively studied. AKI was assessed by clinical diagnosis and Kidney Disease Improving Global Outcomes (KDIGO) criteria. Cohorts of children with or without AKI were compared for differences in treatment, resource utilization, and outcomes. Multivariate logistic regression analysis assessed factors associated with risk for AKI. Cost analysis was performed using the Pediatric Health Information System and Healthcare Cost and Utilization Project databases.
Results:
Among 85 children studied, 14 (16.5%) had chart-diagnosed AKI and 24 (28.2%) met KDIGO criteria. Children with AKI had more febrile days and higher thrombosis rates. They had longer vancomycin treatment (8 vs 5 d), higher troughs (27.8 vs 17.5 mg/L), and prolonged hospitalization (19.9 vs 11.1 d). Multivariate analysis found a maximum vancomycin trough level (odds ratio: 1.05, P = 0.003) with a cutoff of 21.7 mg/L predicted AKI.Only 2 of 20 (10%) children who had MRSA isolates with a minimum inhibitory concentration of 2 achieved therapeutic vancomycin levels. Pediatric Health Information System data of 3133 children with AHO treated with vancomycin identified 75 (2.4%) with AKI who had significantly longer lengths of stay (13 vs 7 d) and higher billed charges ($117K vs $51K) than children without AKI.
Conclusions:
Chart documentation of AKI (16.5%) grossly underestimated KDIGO-defined occurrence (28.2%). This study showed that vancomycin-associated AKI required substantially greater resource utilization and higher health care costs. Lowering the targeted trough range, shortening the duration of vancomycin therapy, and considering alternative antibiotics when minimum inhibitory concentration ≥2 will reduce the risk and cost of AKI among children with MRSA AHO.
Level Of Evidence:
Level III-retrospective comparative therapeutic study.
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