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Published on: April 12, 2021
Implementation of a Protocol With a Shortened Vancomycin Prophylaxis Duration is Associated With Reduced Acute Kidney
Paige T Stratton1, Mary Grace Fitzmaurice1, Rachel M Kenney1
1Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA.
Background:
Vancomycin plus an antipseudomonal β-lactam are common antibiotics used for lung transplant surgical prophylaxis, but the optimal post-operative duration is unknown. The study objective was to assess the impact of a shortened antibacterial surgical prophylaxis duration on post-operative acute kidney injury (AKI) in lung transplant recipients.
Methods:
This was an IRB approved, single pre-/post-test quasi-experiment of lung transplant recipients who received post-operative antibiotic prophylaxis from January 1, 2016-September 30, 2020 (pre-group) to October 1, 2020-March 31, 2025 (post-group). The intervention included modifying vancomycin (and cefepime) post-operative prophylaxis durations to 72 h; the previous prophylaxis standard included continuing vancomycin until chest tube removal. The primary endpoint was incidence of AKI, defined by the KDIGO criteria, while receiving post-operative vancomycin up to 14 days. Thirty-day secondary outcomes included surgical site infection (SSI), treatment of lower respiratory-tract infection, and isolation of multi-drug-resistant organisms (MDRO).
Results:
Ninety patients were included-45 pre- and 45 post-intervention. Most patients were men (64.4%) and had a median (IQR) age of 63 (58-68) years. The most common indication for transplant was pulmonary fibrosis (37.8%). The incidence of 14-day AKI was reduced when comparing pre- and post-intervention groups (48.9% vs. 28.9%, p = 0.052), with no differences in SSI (2.2% vs. 2.2%, p = 1.0), treatment of lower respiratory tract infection (57.8% vs. 73.3%, p = 0.120), and isolation of MDRO (15.6% vs. 13.3%, p = 0.764). When accounting for baseline renal function, patients in the post-intervention group had a significantly decreased odds of AKI (adjOR, 0.385; 95%CI, 0.154-0.959).
Conclusion:
Implementation of a shortened post-operative vancomycin prophylaxis duration protocol was associated with reduced odds of AKI in lung transplant recipients, with similar post-operative infectious complications.
Insights
Shortening antibiotic prophylaxis after lung transplants reduced acute kidney injury (AKI) risk. This change maintained similar rates of surgical site infections and other complications, improving patient outcomes.
Area of Science:
- Nephrology
- Transplant Surgery
- Infectious Diseases
Background:
- Optimal duration of post-operative antibiotic prophylaxis in lung transplant recipients remains undefined.
- Current standard often involves prolonged vancomycin use until chest tube removal.
- Assessing the impact of shortened prophylaxis on acute kidney injury (AKI) is crucial.
Purpose of the Study:
- To evaluate the effect of a shortened antibiotic prophylaxis duration on post-operative AKI in lung transplant recipients.
- To compare the incidence of AKI between pre- and post-intervention groups.
Main Methods:
- A quasi-experimental study comparing lung transplant recipients before and after an intervention.
- Intervention: Shortened post-operative vancomycin and cefepime prophylaxis to 72 hours.
- Primary endpoint: Incidence of AKI (KDIGO criteria) within 14 days; secondary outcomes: surgical site infection (SSI), lower respiratory tract infection, and multi-drug-resistant organism (MDRO) isolation.
Main Results:
- The incidence of 14-day AKI decreased from 48.9% in the pre-intervention group to 28.9% in the post-intervention group (p=0.052).
- No significant differences were observed in SSI (2.2% vs. 2.2%), lower respiratory tract infection (57.8% vs. 73.3%), or MDRO isolation (15.6% vs. 13.3%).
- Adjusted analysis revealed significantly decreased odds of AKI in the post-intervention group (adjOR, 0.385; 95%CI, 0.154-0.959).
Conclusions:
- A shortened post-operative vancomycin prophylaxis duration protocol is associated with reduced AKI incidence in lung transplant recipients.
- This strategy did not increase post-operative infectious complications, including SSI, lower respiratory tract infections, or MDRO isolation.
- The findings support optimizing antibiotic stewardship in lung transplantation to mitigate nephrotoxicity while maintaining infection control.
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