Influence of beta-lactam infusion strategy on acute kidney injury [PublishAheadOfPrint]

Background. Limited literature is available assessing nephrotoxicity with prolonged beta-lactam infusions. This study compared the incidence of acute kidney injury (AKI) associated with a prolonged beta-lactam infusion (PI) or an intermittent infusion.

Methods. This was a retrospective, matched cohort study at an academic medical center from July 2006 to September 2015. Adult patients who received piperacillin-tazobactam (TZP), cefepime (FEP), or meropenem (MEM) for at least 48 hours were evaluated. Patients were excluded for pre-existing renal dysfunction or pregnancy. The primary outcome was difference in incidence of AKI evaluated using the RIFLE criteria. Patients in the intermittent group were matched three-to-one to patients in the PI group based on the following: beta-lactam agent, age, gender, Charlson Comorbidity Index, baseline creatinine clearance, hypotension, receipt of vancomycin, and treatment in an intensive care unit.

Key Results. A total of 2,390 were included in the matched analysis with 1,700 receiving intermittent infusions and 690 receiving PI. The incidence of AKI was similar in the PI group compared to intermittent (21.6% vs 18.6%, p = 0.1). After multivariate regression, PI was not associated with increased odds of AKI [OR of 1.07 (95% CI 0.83-1.39)]. Independent predictors of AKI included: TZP therapy, concomitant nephrotoxins, hypotension, and heart failure.

Conclusions. Although AKI was numerically more common in patients receiving prolonged beta-lactam infusions than those receiving intermittent infusions, prolonged infusion was not an independent risk factor for AKI.

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