Fever and Reversible Laboratory Abnormalities Associated with Prolonged Use of Piperacillin–Tazobactam in Children

Patel, Abhishek; Mao, Kuo Rei; McNeil, J. Chase; Kaplan, Sheldon L.; Vallejo, Jesús G.

doi:10.1097/inf.0000000000000748

Cited by 7 publications

(6 citation statements)

References 9 publications

(8 reference statements)

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“…The association of other antimicrobials with vAKI that are not typically considered nephrotoxic should not be immediately discounted or speculated to have been due to underlying patient factors and pathophysiologies that were not captured in the multivariable analysis and require further study. [ 37 ] The analysis we have performed is in agreement with recent reports of piperacilln/tazobactam associations vAKI, which has only been recently identified. [ 38 , 39 ] The strength of the associations of nafcillin and clindamycin with vAKI warrant that the use of nafcillin or clindamycin with vancomycin should be investigated further.…”

Section: Resultssupporting

confidence: 90%

Vancomycin associated acute kidney injury in pediatric patients

et al. 2018

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IntroductionVancomycin associated acute kidney injury (vAKI) is a well known complication in pediatric patients. Identification and characterization of the incidence and risk factors for vAKI in the pediatric population would assist clinicians in potentially preventing or mitigating vAKI.Methods and materialsA 6 year retrospective cohort study was designed. Patients were included if they were < 19 years of age, received vancomycin as inpatients, and had a baseline SCr and one other SCr drawn during and up to 72 hours after the discontinuation of vancomycin. Data collection included patient demographics, vancomycin doses and length of therapy, vancomycin serum concentrations, and concomitant medications. The Kidney Disease Improving Global Outcomes (KDIGO) criteria were used to characterize acute kidney injury. Descriptive statistical methods were used and ordinal logistic regression was employed to determine variables significantly associated with vAKI.ResultsA total of 7,095 patients met study criteria (55.4% male, median age 4.1 years (IQR 0.67–11.2 years)). Mechanical ventilation was used in 7.9% (n = 563) and mortality was 4.9% (n = 344). A total of 153 concomitant medications were identified. A median of 5 (IQR 3–7) SCr values were obtained and median SCr prior to vancomycin was 0.39 (IQR 0.28–0.57) mg/dL (CrCl 134±58 mL/min/1.73m2). Vancomycin was administered for a median of 2 (IQR 1–3) days (14.9±1.6 mg/kg/dose). vAKI was present in 12.2% (n = 862: KDIGO stage 1 (8.30%, n = 589), KDIGO stage 2 (1.94%, n = 138) KDIGO stage 3 (1.89%, n = 134)). Mean vancomycin serum concentration at 6–8 hours after a dose for patients with vAKI (10.7±8.9 mg/L) was significantly, but not clinically different for patients with no vAKI (7.5±6.3 mg/L). (p<0.05) Ordinal logistic regression identified total dose of vancomycin, vancomycin administration in the intensive care unit, and concomitant medication administration as significant for vAKI. In particular, concomitant administration of several different medications, including nafcillin, clindamycin, and acetazolamide, were noted for strong associations with vAKI. (p<0.05)ConclusionsModerate to severe acute kidney injury due to vancomycin is infrequent in children and associated with concomitant medication use and total dose of vancomycin. Serum vancomycin concentrations are not useful predictors of vAKI in the pediatric population.

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Section: Resultssupporting

confidence: 90%

Vancomycin associated acute kidney injury in pediatric patients

et al. 2018

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“…[32][33][34] Specific reports of adverse reactions associated with PT are related to prolonged use. 33 Our study showed no difference in days of intravenous antibiotics in either group. Mean days on PT was approximately 5 days, with no short-term adverse reactions or antibiotic related complications.…”

Section: Discussionmentioning

confidence: 99%

IMPPACT (Intravenous Monotherapy for Postoperative Perforated Appendicitis in Children Trial)

et al. 2021

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Background: Perforated appendicitis is the most common cause of intraabdominal abscess (IAA) in children. The optimal postoperative antibiotic regimen to reduce IAA has evolved in the last decade from triple-drug to 2drug therapy (CM). Recent retrospective studies show decreased infectious complications with monotherapy PT. To date prospective comparative data are lacking. Therefore, a prospective randomized trial comparing PT versus CM was conducted. Methods: A multi-institutional prospective randomized trial was performed in children with perforated appendicitis comparing postoperative antibiotic regimens PT or CM. The primary outcome was 30-day postoperative IAA formation. Perforation was strictly defined as a hole in the appendix or fecalith in the abdomen, documented with intraoperative photographs. Results: One hundred sixty-two patients were enrolled during the study period. No differences in age, weight, or duration of presenting symptoms were identified. In addition, length of stay, duration of intravenous antibiotic treatment, discharge oral antibiotic treatment, and antibiotic-related complications did not differ between groups. Compared to the CM group, the PT group had significantly lower IAA rate [6.1% vs 23.8%, odd ratio (OR) 4.80, P ¼ 0.002], lower postoperative computed tomography imaging rate (13.9% vs 29.3%, OR 2.57, P ¼ 0.030), and fewer emergency room visits (8.8% vs 26.4%, OR 3.73, P ¼ 0.022). Multivariate logistic regression analysis found the use of CM versus PT (OR 9.21, P ¼ 0.021) to be the most significant predictor for developing IAA. Conclusions: In children with perforated appendicitis, postoperative monotherapy with PT is superior to standard 2-drug therapy with CM and does not increase antibiotic-related complications or antibiotic exposure duration.

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“…29 Tazocin use in children is associated with adverse reactions, characterized by fever, rash, hematologic abnormalities, and transaminitis. 30 Gentamicin is associated with nephrotoxicity and ototoxicity; therefore, drug levels have to be carefully monitored. 31,32 In the case of biliary atresia (BA) treatment, information on serious side effects of the antibiotics is missing, but reports on increasing adverse events and resistant infections in other underlying diseases are worrying.…”

Section: Discussionmentioning

confidence: 99%

The Intestinal Flora at Kasai Procedure in Children with Biliary Atresia Appears Not to Affect Postoperative Cholangitis

et al. 2020

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Introduction Evidence supports long-term oral antibiotic prophylaxis to prevent cholangitis after Kasai procedure. Data regarding perioperative intravenous prophylaxis are lacking. Ascending pathogens from the intestine are made responsible for recurrent cholangitis. Therefore, we analyzed the flora in the upper jejunum during the Kasai procedure and their potential impact on postoperative cholangitis. Materials and Methods In 26 patients, swabs were taken at the bowel prepared for the Roux-en-Y-loop. Our postoperative protocol includes intravenous third-generation cephalosporins for 2 weeks and rectal steroids starting at day 4. Cholangitis was defined as the postoperative reappearance of acholic stools or increase of serum bilirubin in combination with fevers or increase of inflammatory parameters. In this scenario, Tazocin was administered for another 2 weeks. Results Swabs remained sterile in nine patients (34.6%). In 17 patients (65.4%), gram-positive and gram-negative pathogens were identified; all belonging to physiological intestinal flora. A total of 96.2% pathogens were covered by the antibiotic prophylaxis. The cholangitis incidence was 55.6% in the sterile cohort, and 23.5% in the gram-positive and gram-negative cohort (p = 0.06). In the cholangitis cohort, no significant differences were detected for the age at Kasai and the pre- and postoperative total bilirubin. Conclusion We found that our antibiotic regiment covered bacteria in the upper gastrointestinal (GI) tract in the majority of our patients at the time of Kasai. Nonetheless, a significant proportion of patients developed signs of cholangitis. There was no higher rate of cholangitis in patients with resistant bacteria. Thus, our data do not support the hypothesis of extended postoperative intravenous antibiotics to prevent ascending cholangitis.

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Fever and Reversible Laboratory Abnormalities Associated with Prolonged Use of Piperacillin–Tazobactam in Children

Cited by 7 publications

References 9 publications

Vancomycin associated acute kidney injury in pediatric patients

Vancomycin associated acute kidney injury in pediatric patients

IMPPACT (Intravenous Monotherapy for Postoperative Perforated Appendicitis in Children Trial)

The Intestinal Flora at Kasai Procedure in Children with Biliary Atresia Appears Not to Affect Postoperative Cholangitis

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