title: Renal outcome after vancomycin treatment and renal replacement therapy in patients with severe sepsis and septic shock: a retrospective study.
abstract: OBJECTIVE
  Acute kidney injury during systemic infections is common; however, renal outcome is poorly investigated. The increase of multiresistant pathogens leads to the use of potential nephrotoxic antibiotics as vancomycin. We investigated the impact of vancomycin and renal replacement therapy (RRT) for renal recovery during sepsis.
  
  
  METHODS
  This is a retrospective data analysis of 1159 patients with severe sepsis or septic shock. Logistic regression models were performed.
  
  
  RESULTS
  In total, 390 (33.6%) patients required RRT during intensive care unit (ICU) stay; 233 (20.1%), at discharge. Admission estimated glomerular filtration rate (eGFR) predicted the need of RRT during stay (odds ratio [OR] 0.969 [0.959-0.979] per increase of 1 mL/min, P<.001) and the prolonged need of RRT at ICU discharge (OR 0.979 [0.967-0.990], P<.001). Survivors without any RRT showed an improvement of eGFR at discharge, whereas patients after RRT did not (7.1 vs 0.8 mL/[min 1.73 m2], P<.001). The use (OR 1.648 [1.067-2.546], P<.05) and duration of vancomycin treatment (OR 1.043 [1.004-1.084] per each additional treatment day, P<.05) were predictors for ongoing RRT at discharge.
  
  
  CONCLUSIONS
  Estimated GFR at ICU admission predicts renal outcome, whereas the use of vancomycin increases the probability of a prolonged need for RRT at discharge from ICU. The use of alternative antibiotics for certain patients, indicated by eGFR at admission, might be considered.
authors.affiliation: Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany. Electronic address: Gordon.Otto@med.uni-jena.de.
authors.forename: Gordon P
authors.initials: GP
authors.lastname: Otto
authors.affiliation: Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors.forename: Maik
authors.initials: M
authors.lastname: Sossdorf
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Breuel
authors.affiliation: Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schlattmann
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors.forename: Ole
authors.initials: O
authors.lastname: Bayer
authors.affiliation: Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors.forename: Ralf A
authors.initials: RA
authors.lastname: Claus
authors.affiliation: Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors.forename: Niels C
authors.initials: NC
authors.lastname: Riedemann
authors.affiliation: Department of Internal Medicine III-Nephrology, Jena University Hospital, Jena, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Busch
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy*; D012737:Sex Factors; D012772:Shock, Septic / Q000188:drug therapy; D014640:Vancomycin / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Acute kidney injury; Renal outcome; Renal replacement therapy; Sepsis; Vancomycin