Archive for January 9, 2018

Risk of acute kidney injury in patients on concomitant VANCO and P-TAZO compared to those on VANCO and cefepime.

Clin Infect Dis January 15, 2017  V.64 N.2 P.116-123

(http://dx.doi.org/10.1093/cid/ciw709)

EDITORIAL

Navalkele B et al.

Abstract

Background.

Recent evidence suggests that among patients receiving vancomycin, receipt of concomitant piperacillin–tazobactam increases the risk of nephrotoxicity. Well-controlled, adequately powered studies comparing rates of acute kidney injury (AKI) among patients receiving vancomycin + piperacillin–tazobactam (VPT) compared to similar patients receiving vancomycin + cefepime (VC) are lacking. In this study we compared the incidence of AKI among patients receiving combination therapy with VPT to a matched group receiving VC.

Methods.

A retrospective, matched, cohort study was performed. Patients were eligible if they received combination therapy for ≥48 hours. Patients were excluded if their baseline serum creatinine was >1.2mg/dL or they were receiving renal replacement therapy. Patients receiving VC were matched to patients receiving VPT based on severity of illness, intensive care unit status, duration of combination therapy, vancomycin dose, and number of concomitant nephrotoxins. The primary outcome was the incidence of AKI. Multivariate modeling was performed using Cox proportional hazards.

Results.

A total of 558 patients were included. AKI rates were significantly higher in the VPT group than the VC group (81/279 [29%] vs 31/279 [11%]). In multivariate analysis, therapy with VPT was an independent predictor for AKI (hazard ratio = 4.27; 95% confidence interval, 2.73–6.68). Among patients who developed AKI, the median onset was more rapid in the VPT group compared to the VC group (3 vs 5 days P =< .0001).

Conclusion.

The VPT combination was associated with both an increased AKI risk and a more rapid onset of AKI compared to the VC combination.

abstract

https://academic.oup.com/cid/article/64/2/116/2698878

PDF (CLIC en PDF)

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January 9, 2018 at 4:24 pm

2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea

Clinical Infectious Diseases November, 29  2017  V.65  N.12 P.1963–1973

IDSA GUIDELINE

Andi L Shane; Rajal K Mody; John A Crump; Phillip I Tarr; Theodore S Steiner …

These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. They are not intended to replace physician judgement regarding specific patients or clinical or public health situations. This document does not provide detailed recommendations on infection prevention and control aspects related to infectious diarrhea.

FULL TEXT

https://academic.oup.com/cid/article/65/12/1963/4655039

PDF (hacer CLIC en PDF)

January 9, 2018 at 7:59 am


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