title: Antibiotic prophylaxis by teicoplanin and risk of acute kidney injury in cardiac surgery.
abstract: OBJECTIVE
  To investigate the risk of acute kidney injury (AKI) associated with antibiotic prophylaxis with teicoplanin in cardiac surgery.
  
  
  METHODS
  Observational cohort study. Data were gathered from patient charts and national registers.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  All adult patients who underwent cardiac surgery at the authors' institution between January 1, 2010 and July 31, 2013 were eligible for the study.
  
  
  METHODS
  The risk for AKI associated with teicoplanin prophylaxis was estimated by multivariate logistic regression.
  
  
  RESULTS
  The primary endpoint, AKI, was defined according to the Acute Kidney Injury Network criteria stage 1, as an increase of postoperative serum creatinine by ≥26 μmol/L (≥0.3 mg/dL) or a relative increase of ≥50% compared to the preoperative value. The authors included 2,809 patients, and 1,056 (38%) received a combination of teicoplanin and cloxacillin for antibiotic prophylaxis. The remaining 1,753 (62%) patients received only cloxacillin and constituted the control group. AKI occurred in 32% (n = 343) in the teicoplanin group compared to 29% (n = 517) in the control group. There was a significant association between antibiotic prophylaxis with teicoplanin and AKI; multivariate adjusted odds ratio (OR): 1.41 (95% confidence interval [CI] 1.18-1.70). There was a dose-dependent relationship; 600 mg OR: 1.48 (95% CI 1.17-1.87), and 400 mg OR: 1.34 (95% CI 1.06-1.71). The findings were confirmed in several subgroup analyses; men (OR: 1.27; 95% CI 1.03-1.56); women (OR: 1.90; 95% CI 1.30-2.80); normal renal function (OR: 1.31; 95% CI 1.07-1.60), and reduced renal function (OR: 1.80; 95% CI 1.13-2.85).
  
  
  CONCLUSIONS
  Antibiotic prophylaxis with teicoplanin was associated with an increased risk of AKI after cardiac surgery. The relative risk of AKI was higher in women and in patients with impaired renal function.
authors.affiliation: Department of Medicine, Karolinska Institutet.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Olsson
authors.affiliation: Department of Medicine, Karolinska Institutet; Department of Emergency Medicine, Karolinska University Hospital.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Holzmann
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital; Department of Molecular Medicine and Surgery, Karolinska Institutet Stockholm, Sweden. Electronic address: Ulrik.Sartipy@karolinska.se.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Sartipy
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000009:adverse effects* / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017334:Teicoplanin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin
keywords: acute kidney injury; antibiotic prophylaxis; cardiac surgical procedure; teicoplanin