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J Cardiothorac Vasc Anesth. 2015;29(3):626-31. doi: 10.1053/j.jvca.2014.08.010. Epub 2014 Dec 24.

Antibiotic prophylaxis by teicoplanin and risk of acute kidney injury in cardiac surgery.

Author information

1
Department of Medicine, Karolinska Institutet.
2
Department of Medicine, Karolinska Institutet; Department of Emergency Medicine, Karolinska University Hospital.
3
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.

Abstract

OBJECTIVE:

To investigate the risk of acute kidney injury (AKI) associated with antibiotic prophylaxis with teicoplanin in cardiac surgery.

DESIGN:

Observational cohort study. Data were gathered from patient charts and national registers.

SETTING:

University hospital.

PARTICIPANTS:

All adult patients who underwent cardiac surgery at the authors' institution between January 1, 2010 and July 31, 2013 were eligible for the study.

INTERVENTIONS:

The risk for AKI associated with teicoplanin prophylaxis was estimated by multivariate logistic regression.

MEASUREMENTS AND MAIN 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.

KEYWORDS:

acute kidney injury; antibiotic prophylaxis; cardiac surgical procedure; teicoplanin

PMID:
25543214
DOI:
10.1053/j.jvca.2014.08.010
[Indexed for MEDLINE]

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