Epidemiology of infection in critically ill patients with acute renal failure

Reynvoet, Emmelie; Vandijck, Dominique; Blot, Stijn; Dhondt, Annemieke; Waele, Jan J. De; Claus, Stefaan; Buyle, Franky; Vanholder, Raymond; Hoste, Eric

doi:10.1097/ccm.0b013e3181a03961

Cited by 59 publications

(40 citation statements)

References 45 publications

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“…Indications for renal replacement therapy (RRT) as well as the modality chosen [i.e., intermittent (duration 2-4 h per treatment session) or continuous hemodialysis (IHD/CHD), continuous veno-venous hemofiltration (CVVH), or slow extended daily dialysis (SLEDD) (duration 6-12 h per treatment session)] were determined in consensus between the attending intensivist and nephrologist [31]. Criteria for initiation of RRT for AKI included volume overload and oliguria, acidosis, hyperkalemia, uremic symptoms, or uremia [32].…”

Section: Processes Of Carementioning

confidence: 99%

Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

et al. 2011

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Intensive care unit (ICU) patients frequently undergo contrast-enhanced radiographic examinations, which carries a risk for development of contrast-associated acute kidney injury (CA-AKI). Data on this in ICU patients are scarce. The aim of this study was therefore to evaluate the epidemiology and short- and long-term outcomes of CA-AKI in ICU patients. A retrospective single-centre cohort study covering the period 1 March 2004 to 31 December 2008 on ICU patients who underwent a radiography examination with parenteral administration of iodinated radio contrast media was conducted. Data analysis included univariate and multivariate analyses of patients with and without CA-AKI. A total of 787 ICU patients were included in the study. CA-AKI occurred in 128 (16.3%) and was associated with higher need for RRT [30 (4.6%) vs. 21 (16.4%), p < 0.001], worse kidney function at discharge, longer length of ICU and hospital stay, and higher 28-day and 1-year mortality [28-day: 86 (13.1%) vs. 46 (35.9%), p < 0.001, and 1-year: 158 (24.0%) vs. 71 (55.5%), p < 0.001]. Higher serum creatinine, lower mean arterial pressure, and administration of diuretics and vasoactive therapy were associated with development of CA-AKI in multivariate analysis. After correction for confounders we found that CA-AKI was associated with 28-day mortality in this cohort of ICU patients (odds ratio = 2.742, 95% confidence interval 1.374-5.471). CA-AKI occurred in one out of six ICU patients who underwent a contrast-enhanced radiography examination and was associated with both short-and long-term worse outcomes such as need for RRT, worse kidney function at discharge, increased length of stay in the ICU and hospital, and mortality

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Section: Processes Of Carementioning

confidence: 99%

Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

et al. 2011

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“…Critically ill patients requiring renal replacement therapy (RRT) are at greater risk for infection (2), and the risk of nosocomial bloodstream infection sharply increases after initiation of RRT (3). However, only a fraction (around 16%) of the nosocomial bloodstream infection in such patients is attributed to the vascular access (2).…”

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confidence: 99%

Continuous Renal Replacement Therapy May Increase the Risk of Catheter Infection

Parienti

Dugué

Daurel³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives:Little is known about the risks of catheter-related infections in patients undergoing intermittent hemodialysis (IHD) as compared with continuous renal replacement therapy (CRRT) techniques. We compared the two modalities among critically ill adults requiring acute renal replacement therapy (RRT).Design, setting, participants, & measurements: We used the multicenter Cathedia study cohort of 736 critically ill adults requiring RRT. Cox marginal structural models were used to compare time to catheter-tip colonization at removal (intent-totreat, primary endpoint) among patients who started IHD (n ‫؍‬ 470) versus CRRT (n ‫؍‬ 266). On-treatment analysis was also conducted to take into account changes in prescription of RRT modality.Results: Hazard rate of catheter-tip colonization did not increase within the first 10 days of catheter use. Predictors of catheter-tip colonization were higher lactate levels and hypertension, while systemic antibiotics, antiseptics-impregnated catheters, and mechanical ventilation were associated with decreased risk. The incidence of catheter-tip colonization per 1000 catheter-days was 42.7 in the IHD group and 27.7 in the CRRT group (P < 0.01). This association was no longer significant after correction for channeling bias (weighted HR, 0.96; 95% CI: 0.77 to 1.20, P ‫؍‬ 0.73). On-treatment analysis revealed an increased risk of primary endpoint during CRRT exposure as compared with IHD exposure (weighted HR, 0.71; 95% CI: 0.56 to 0.92, P < 0.009).Conclusions: Our results do not support the use of CRRT when IHD could be an alternative to reduce the risk of catheter-related infection.

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“…Gram-positive infections are common among patients with chronic renal failure in the ambulatory care setting [1] and patients with acute kidney injury (AKI) in the critical care environment [2] . Thus, it is likely that dalbavancin will be prescribed extensively for patients with renal failure.…”

Section: Introductionmentioning

confidence: 99%

Modeled Dalbavancin Transmembrane Clearance during Intermittent and Continuous Renal Replacement Therapies

Vilay¹,

Shah

Churchwell

et al. 2010

Blood Purif

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Background/Aims: Knowledge of dalbavancin renal replacement therapy (RRT) disposition is vital to ensure appropriate dosing. In vitro models of continuous RRT and intermittent hemodialysis (IHD) were used to determine dalbavancin transmembrane clearance (CLtm). Methods: Dalbavancin saturation and sieving coefficients (SCs) were determined for hemodialysis and hemofiltration therapies, respectively, using various hemodiafilter and effluent rate combinations. Dalbavancin CLtm estimates were calculated from observed saturation and SCs. Results: Saturation and SCs for both modalities of continuous dialysis and hemofiltration and IHD with high permeability hemodiafilters were small. Nonetheless, during continuous RRT with high dialysate and ultrafiltration rates, dalbavancin CLtm (0.20–1.26 ml/min) matched and often exceeded literature-derived dalbavancin renal clearances. Dalbavancin CLtm was undetectable during IHD with low-permeability hemodialyzers, but with high-permeability hemodialyzers, substantial CLtm (1.90–2.43 ml/min) was noted. Conclusion: Dalbavancin CLtm is dependent on RRT modality, hemodiafilter, and effluent flow. Dalbavancin doses may need to be adjusted depending on RRT parameters.

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Epidemiology of infection in critically ill patients with acute renal failure

Abstract: Infection occurred in four fifths of critically ill patients with ARF treated with RRT and was in an unadjusted analysis associated with longer LOS and higher mortality. After correction for other covariates, infection was no longer associated with in-hospital mortality.

Cited by 59 publications

References 45 publications

Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

Continuous Renal Replacement Therapy May Increase the Risk of Catheter Infection

Modeled Dalbavancin Transmembrane Clearance during Intermittent and Continuous Renal Replacement Therapies

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