Try to avoid vancomycin/pip-tazo
This study used a retrospective matched cohort technique – not a randomized controlled trial, but a reasonable methodology. Patients in both VC and VPT groups had similar baseline characteristics in terms of age, length of ICU stay, Charlson comorbidity index score, baseline creatinine, and use of concomitant nephrotoxins. The groups had great similarity. The rate of AKI was higher among patients receiving VPT compared to those receiving VC combination therapy. Based on RIFLE criteria, 81 patients in the VPT group developed AKI compared to 31 patients in the VC group (29.0% vs 11.1%; hazard ratio [HR] = 4.0; 95% confidence interval [CI], 2.6–6.2; P < .0001). Rates of AKI were also higher per AKIN criteria (32% in the VPT vs 14% in the VC group; HR = 3.5; 95% CI, 2.3–5.2; P < .0001) and per vancomycin consensus guidelines definition (24% in VPT vs 8.2% in VC; HR = 4.4; 95% CI, 2.7–7.3; P < .0001). In multivariate analysis, after controlling for residual differences between the VPT and VC groups (race, gender, admission from home, comorbid conditions, presence of septic shock, baseline serum white blood cell count, and source of infection), VPT was independently associated with RIFLE-defined AKI (HR = 4.3; 95% CI, 2.7–6.7; P < .0001). The multivariate analysis adjust for major potential confounders, thus the groups are equalized for potential characteristics that might have increased the risk for AKI. The median length of stay after initiation of combi...
Source: DB's Medical Rants - Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
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