title: Standard operating procedures for antibiotic therapy and the occurrence of acute kidney injury: a prospective, clinical, non-interventional, observational study.
abstract: BACKGROUND
  Acute kidney injury (AKI) occurs in 7% of hospitalized and 66% of Intensive Care Unit (ICU) patients. It increases mortality, hospital length of stay, and costs. The aim of this study was to investigate, whether there is an association between adherence to guidelines (standard operating procedures (SOP)) for potentially nephrotoxic antibiotics and the occurrence of AKI.
  
  
  METHODS
  This study was carried out as a prospective, clinical, non-interventional, observational study. Data collection was performed over a total of 170 days in three ICUs at Charité - Universitaetsmedizin Berlin. A total of 675 patients were included; 163 of these had therapy with vancomycin, gentamicin, or tobramycin; were >18 years; and treated in the ICU for >24 hours. Patients with an adherence to SOP >70% were classified into the high adherence group (HAG) and patients with an adherence of <70% into the low adherence group (LAG). AKI was defined according to RIFLE criteria. Adherence to SOPs was evaluated by retrospective expert audit. Development of AKI was compared between groups with exact Chi2-test and multivariate logistic regression analysis (two-sided P <0.05).
  
  
  RESULTS
  LAG consisted of 75 patients (46%) versus 88 HAG patients (54%). AKI occurred significantly more often in LAG with 36% versus 21% in HAG (P = 0.035). Basic characteristics were comparable, except an increased rate of soft tissue infections in LAG. Multivariate analysis revealed an odds ratio of 2.5-fold for LAG to develop AKI compared with HAG (95% confidence interval 1.195 to 5.124, P = 0.039).
  
  
  CONCLUSIONS
  Low adherence to SOPs for potentially nephrotoxic antibiotics was associated with a higher occurrence of AKI.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN54598675. Registered 17 August 2007.
authors.forename: Irit
authors.initials: I
authors.lastname: Nachtigall
authors.forename: Sascha
authors.initials: S
authors.lastname: Tafelski
authors.forename: Karsten
authors.initials: K
authors.lastname: Günzel
authors.forename: Alexander
authors.initials: A
authors.lastname: Uhrig
authors.forename: Robert
authors.initials: R
authors.lastname: Powollik
authors.forename: Andrey
authors.initials: A
authors.lastname: Tamarkin
authors.forename: Klaus D
authors.initials: KD
authors.lastname: Wernecke
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000009:adverse effects; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012121:Respiration, Artificial; D013997:Time Factors; D014031:Tobramycin / Q000008:administration & dosage / Q000009:adverse effects; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin; D014031:Tobramycin