title: Outbreak of acute renal failure due to cefodizime-vancomycin association in a heart surgery unit.
abstract: OBJECTIVE
  To describe an outbreak of acute renal failure (ARF) occurring in a group of patients undergoing open-heart surgery, simultaneously to a change in perioperative antibiotic prophylaxis.
  
  
  METHODS
  Case series.
  
  
  METHODS
  A nine-bed heart surgery intensive care unit, serving a 1,300-bed University teaching hospital.
  
  
  METHODS
  Thirty-two patients undergoing open-heart surgery during an 11-day period, when the preoperative surgical prophylaxis protocol had been changed from the usual antibiotic association of ceftriaxone + vancomycin to cefodizime + vancomycin.
  
  
  RESULTS
  ARF occurred in 16 of the 32 (50%) patients exposed to the new antibiotic prophylaxis regimen; seven patients had oliguric ARF, and nine patients had an increase in serum creatinine (SCr) levels >50% over 24-48 h. In the seven patients with oliguric ARF, SCr increased from a median preoperative level of 88 micromol/l (80-115 micromol/l) to a peak value of 725 micromol/l (521-857 micromol/l) in 5 days (4-6). Eight patients out of the sixteen with ARF (50%) were diabetics, as opposed to none of the 16 patients not experiencing ARF. Renal biopsy (three patients) showed tubular dilation and necrosis, interstitial edema, and lymphomononuclear infiltrate of moderate degree. Only one patient required hemodialysis, and all recovered renal function. No other cases of unexplained ARF occurred in the unit after the original prophylaxis protocol was resumed.
  
  
  CONCLUSIONS
  The simultaneous infusion of cefodizime and vancomycin may involve a high risk of substantial renal function derangement, especially in diabetics.
authors.affiliation: Reparto Acuti, Dipartimento di Clinica Medica, Nefrologia & Scienze della Prevenzione, Università degli Studi di Parma, Via Gramsci 14 - 43100, Parma, Italy. enrico.fiaccadori@unipr.it
authors.forename: E
authors.initials: E
authors.lastname: Fiaccadori
authors.forename: U
authors.initials: U
authors.lastname: Maggiore
authors.forename: A
authors.initials: A
authors.lastname: Arisi
authors.forename: A
authors.initials: A
authors.lastname: Cabassi
authors.forename: C
authors.initials: C
authors.lastname: Beghi
authors.forename: R
authors.initials: R
authors.lastname: Campodonico
authors.forename: T
authors.initials: T
authors.lastname: Gherli
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures; D002439:Cefotaxime / Q000009:adverse effects* / Q000031:analogs & derivatives*; D002511:Cephalosporins / Q000009:adverse effects*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014640:Vancomycin / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D014640:Vancomycin; D002439:Cefotaxime; C033356:cefodizime