Background: Increasing evidence suggests that administration of combination vancomycin and piperacillin-tazobactam (VPT) increases the incidence of acute kidney injury (AKI) beyond that of vancomycin alone. But these investigations have not evaluated AKI risk specifically in an increasingly prevalent obese population in whom VPT pharmacokinetics are altered. Objective: To evaluate AKI risk with VPT administration to patients with obesity. Methods: We conducted a multicenter retrospective study of obese patients admitted to 2 separate academic teaching hospitals from January 2010 to December 2021, who received VPT, or vancomycin plus either cefepime, meropenem, or ceftazidime. The primary outcome evaluated AKI when patients were treated with or without VPT. Results: A total of 227 patients were evaluated (114 in VPT, vs 113 in control group). Overall, body mass index (35.6 kg/m2 ± 4.8vs 36.1 kg/m2 ± 5.2; P = .44) was similar between the VPT and control groups respectively. Total vancomycin dose on day 1 of antibiotic therapy (3,432 mg ± 935 vs 2,732 mg ± 912; P < .01) and nephrotoxin administration (75.4% vs 62.8%; P = .04) were higher in the VPT group. Incidence of AKI was higher in the VPT group (37.7%vs 14.2%; P = .01) and on regression analysis VPT was predictive of developing AKI (OR = 3.9; 95% CI = 2.0-7.7; P < .01). Conclusion and Relevance: In this retrospective study, the incidence of AKI was increased in obese patients receiving therapy with VPT. Vancomycin combination therapy with ceftazidime, cefepime, and meropenem appeared to be safe and was associated with less nephrotoxicity. Cautious use of VPT and further investigation with larger studies are warranted in this area.
Background Multiple studies have shown that antibiotic utilization increased during the COVID-19 pandemic. However, the impact of this increased utilization has not been well established. The aim of this study is to describe the trends in minimum inhibitory concentrations for various antibiotics against common gram-negative pathogens observed since the start of the COVID-19 pandemic as compared to previous years. Methods This retrospective study was conducted at the Memphis VA. All respiratory, urine, and blood culture MicroScan results run from October 2017-March 2021 were analyzed. Only inpatient and emergency department data was included. The MIC50 and MIC90 of seven antibiotics for four of the most common pathogens were trended by quarterly intervals. Results MIC50 and MIC90 were compared using standardized breakpoints. As compared to previous years, Pseudomonas aeruginosa was noted to have the most sustained increase in MIC90 across various antibiotics. In the last 3 quarters of the study time frame, piperacillin-tazobactam mean MIC90 increased from 32 to 64, cefepime from 8 to > 16, and meropenem from 4 to > 8. Escherichia coli had a sustained increase in ceftriaxone MIC90 from < 1 to > 8 in the final quarter of 2020 and beginning of 2021. Klebsiella pneumonia was also found to have a sustained increase in cefepime mean MIC90 from < 1 to > 16 during the year of 2020, with return to previous MIC90 the following quarters. Conclusion Previous studies have clearly demonstrated a widespread increase in antibiotic utilization during the COVID era. Our study demonstrates how even short-term increases in antibiotic use can lead to shifts in MIC, if not outright resistance. This was demonstrated across multiple common gram-negative pathogens and to various broad-spectrum antibiotics which were commonly used more frequently during COVID-19. Further analysis will be needed to determine whether these trends continue or whether the decrease in antibiotic utilization in the recent months will lead to similar decrease in MIC. Disclosures All Authors: No reported disclosures
Background Respiratory cultures can take up to five days to grow, time that can be crucial in treating patients with serious infections. Newer rapid microbiological identification tests are designed to shorten this delay between specimen collection and test result. The BioFire® FilmArray® Pneumonia Panel is a multiplex PCR panel that can identify 8 viral, 18 bacterial, and 7 resistance gene targets in one hour. In this study, we aimed to calculate the predictive value of this test and its utility in the clinical setting. Methods This retrospective study compared BioFire® FilmArray® Pneumonia Panel results to respiratory cultures run at our center from 3/1/2020 to 2/28/2021. For every BioFire sample, a respiratory culture was run concurrently. We examined correlations between these two tests using data collected from the microbiology laboratory and the electronic medical record. Results 190 BioFire samples from 124 patients were submitted for processing. Of these, 148 samples had a concomitant respiratory culture result that grew organisms that BioFire could detect. BioFire and culture results were compared, and sensitivity and specificity were calculated on a per-sample basis. Sensitivity was calculated at 91%, specificity at 67%, positive predictive value at 46%, and negative predictive value at 96%. BioFire detected 30 resistance genes total, including mecA/C and MREJ, CTX-M, and KPC. The sensitivity and negative predictive value for BioFire resistance gene detection was 100%. However, specificity was 94-98%, and the positive predictive value ranged between 25-41% when compared to culture. Conclusion Despite the promise of faster results and better screening, our data suggests that further study is needed to determine the utility of the BioFire pneumonia panel. The strength of the panel appears to lie in its negative predictive value and sensitivity, but as a positive predictive tool, it is suboptimal. Disclosures All Authors: No reported disclosures
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