Association of appropriate empiric antimicrobial therapy with acute kidney injury in gram-negative sepsis

Despite advances in sepsis management, the relationship between appropriate empiric antibiotic therapy and acute kidney injury (AKI) in sepsis remains unclear. This study aimed to examine the association of appropriate empiric antimicrobial therapy with AKI in early onset sepsis caused by gram-negative bloodstream infections.

We conducted a retrospective study of gram-negative bloodstream infection episodes in adult patients with early onset sepsis, using the Premier Healthcare Database from 2016 to 2020. The exposure was appropriate empiric antibiotic therapy determined by antibiotic regiments and antimicrobial susceptibilities of pathogens. The primary outcome was development of AKI or death by day 7 after the onset of sepsis. AKI was defined using the Kidney Disease Improving Global Outcome criteria based on serum creatinine levels, as urine output data were not available. The multivariable regression analysis was used to examine the association between appropriate empiric antibiotic therapy and the outcomes.

We identified 8565 patients with gram negative sepsis. In the total sample, the proportion of appropriate empiric antibiotic therapy was 93.2%, and the prevalence of AKI was 85.3%. Appropriate empiric antibiotic therapy was associated with decreased risk of AKI or death (adjusted odds ratio 0.70, 95% CI 0.52-0.94). For secondary outcomes, appropriate empiric antibiotic therapy was associated with lower AKI, shorter hospital LOS, lower C. difficile infections. However, it was not associated with in-hospital mortality.

Appropriate empiric antibiotic therapy was associated with lower AKI in gram-negative sepsis. Early administration of appropriate antibiotics may prevent development of AKI.