Introduction: Vascular surgery patients have multiple risk factors for renal dysfunction, but acute kidney injury (AKI) is poorly studied in this group. The purpose of this study was to define the incidence, risk factors, and outcomes of AKI in high-risk vascular patients.Methods: Critically ill vascular surgery patients admitted during January–December 2012 were retrospectively analyzed with 1-year follow-up. The endpoint was AKI by established RIFLE creatinine criteria. The primary analysis was between patients with or without AKI, with secondary analysis of post-operative AKI. Outcomes were inpatient and 1-year mortality, inpatient lengths of stay, and discharge renal function.Results: One-hundred and thirty six vascular surgery patients were included, representing 27% of all vascular surgery admissions during the study period. Sixty-five (48%) developed AKI. Independent global risk factors for AKI were diabetes, increasing critical illness severity, and sepsis. While intraoperative blood loss and hypotension were associated with subsequent renal dysfunction, post-operative AKI rates were similar for patients undergoing aortic, carotid, endovascular, or peripheral vascular procedures. All RIFLE grades of AKI were associated with worse outcomes. Overall, patients with AKI had significantly increased short- and long-term mortality, longer inpatient lengths of stay, and worse discharge renal function.Conclusion: AKI is common among critically ill vascular surgery patients. Importantly, the type of surgical procedure appears to be less important than intra- and perioperative management in determining renal dysfunction. Regardless of its severity, AKI is a clinically significant complication that is associated with substantially worse patient outcomes.
BackgroundMultiplex PCR (mPCR) can be used to rapidly identify polymicrobial blood stream infections (BSIs) and guide empiric therapy. In addition rapid identification of potential contaminants, may limit unnecessarily broad empiric therapy. The purpose of this study was to describe the use of mPCR to diagnosis polymicrobial BSIs in hospitalized children, and the impact of this technology on antibiotic prescribing.MethodsWe retrospectively identified children at our institution with polymicrobial BSIs diagnosed by mPCR (Film Array Blood Culture Identification Panel, BioFire Diagnostics) from October 2014 to March 2018. A polymicrobial BSI was defined as any blood isolate with ≥1 bacterial or fungal species. Gram stain results, species identification by mPCR, and final species identification via matrix associated laser deionization time of flight (MALDI-TOF) were determined. Antibiotic prescribing for treatment of each BSI was reviewed.ResultsOverall, 622 patients experienced 961 blood stream infections. There were 54 patients who experienced 68 polymicrobial BSIs (7%). Of the polymicrobial BSIs, 55 (80.9%) were two organisms and 13 (19.1%) were three or more organisms. Of the 68, 44 (64.7%) had the same Gram stain morphology and 24 (35.3%) had different morphology. Antibiotic therapy was broadened, narrowed, and unchanged in 38 (56%), 16 (24%), 14 (21%) of infections, respectively. Common modifications of therapy included addition of aminoglycoside or meropenem when two Gram-negative bacilli were present, and addition of vancomycin when coagulase negative staphylococci (CoNS) were isolated.ConclusionThe use of mPCR commonly led to prompt modification of antibiotic therapy to treat polymicrobial blood stream infections. Identification of CoNS frequently led to broadening of antibiotic therapy, even when other organisms were present.Disclosures
S. Patel, Merck: Grant Investigator, Grant recipient and Research grant. Pfizer: Grant Investigator, Research grant.
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