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Tamma, Pranita D.; Turnbull, Alison E.; Harris, Anthony D.; Milstone, Aaron M.; Hsu, Alice J.; Cosgrove, Sara E.

doi:10.1001/jamapediatrics.2013.196

Cited by 40 publications

(11 citation statements)

References 62 publications

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“…The incidence of renal injury for β-lactams is estimated to be around 10%, which is consistent with the rates of renal injury in our investigation [20][21][22]. Although we did show that the duration of vancomycin therapy was associated with increasing renal injury, the overall rates were not different from patients treated with β-lactam antimicrobials.…”

Section: Discussionsupporting

confidence: 89%

“…Of the 879 patients with bacteremia, which included pediatric intensive care unit patients, 61% received combination therapy. While there was no difference in mortality between the combination and monotherapy treatment groups, 19% of patients in the combination group met their definition of acute kidney injury while the incidence of acute kidney injury in the monotherapy treatment group was 10% (OR = 2.15, 95% CI 2.09-2.21) [20]. Piperacillin/tazobactam was the most commonly prescribed β-lactam (37%) followed by ceftriaxone (30.8%) and cefepime (15%).…”

Section: Discussionmentioning

confidence: 81%

“…β-lactam antimicrobials are also thought to be nephrotoxic in some capacity [19][20][21][22]. Most of the investigations to date have evaluated the incidence or association with renal injury in patients that received a β-lactam in conjunction with another class of antimicrobial, most commonly being an aminoglycoside.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the investigations to date have evaluated the incidence or association with renal injury in patients that received a β-lactam in conjunction with another class of antimicrobial, most commonly being an aminoglycoside. Tamma [20] and colleagues demonstrated that combination therapy with a β-lactam and aminoglycoside was common for definitive treatment of Gram-negative bacteremia and sought to determine whether there was any difference in efficacy and safety between combination therapy and monotherapy. Of the 879 patients with bacteremia, which included pediatric intensive care unit patients, 61% received combination therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Most investigations regarding β-lactam renal injury in the adult and pediatric literature have evaluated the incidence of renal injury of β-lactam therapy in conjunction with an aminoglycoside [20][21][22]. β-lactam monotherapy has consistently shown to have less renal injury as compared to the β-lactam/aminoglycoside combination.…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial Renal Injury in a Pediatric Intensive Care Unit: β-Lactams vs. Vancomycin

2014

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Vancomycin trough (Vt) concentrations of 15-20 mcg/mL have been associated with an increased rate of renal injury in adults. Current data in pediatrics suggests Vts of 15-20 mcg/mL do not increase the risk of renal injury in children admitted to a pediatric intensive care unit (PICU). The primary objective was to determine if a difference exists in the incidence of renal injury in PICU patients receiving a β-lactam as compared with vancomycin therapy with Vts of 15-20 mcg/mL. This was a retrospective cohort study conducted within a PICU within a freestanding tertiary care pediatric hospital. The records of children admitted to the PICU between 10/2008-6/2009 who received vancomycin for ≥48 h targeting higher Vt concentrations of ≥15 mcg/mL for pneumonia, bacteremia, and meningitis were reviewed. This cohort (V group) was compared to children admitted from July 2009-July 2013 who received cefepime or piperacillin/tazobactam for ≥72 h (B group). Serum creatinine values were collected from 48 h before until 48 h after discontinuation of therapy for calculation of estimated glomerular filtration rate. Renal injury was categorized according to pRIFLE. 57 and 112 patients were included in the V and B groups, respectively. OPEN ACCESSPharmacy 2014, 2 277The mean (SD) therapeutic dose of vancomycin was 63.5(17.3) mg/kg/day and the mean (SD) trough was 17.8(3.1). The mean (SD) dose of cefepime was 51(26) mg/kg/dose with an every 8 h interval. The mean (SD) dose of piperacillin/tazobactam was 77(22) mg/kg/dose with an every 6 h interval. The mean (SD) PRISM scores were 10.9(10.2), 4.24(6.4) for the V and B groups, respectively (p < 0.001). Five of 57 and 10 of 112 patients in the V and B groups, respectively, were classified as having injury according to pRIFLE. No patient was classified as having a degree of renal injury greater than the pRIFLE injury. The incidence of renal injury was 8.8% in the V group and 8.9% in the B group, respectively (p = 1). Our observations suggest that maintaining Vt concentrations ≥15 mcg/mL is not associated with an increased rate of renal injury as compared with β-lactam monotherapy in a PICU population.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antimicrobial Renal Injury in a Pediatric Intensive Care Unit: β-Lactams vs. Vancomycin

2014

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Neuroanesthesia and Coexisting Renal Problems

Gupta

Aggarwal

Singhal

2018

Co-Existing Diseases and Neuroanesthesia

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Antibiotische Therapie bei kritisch kranken Kindern – Ist weniger mehr?

Bruns¹,

Dohna-Schwake

2020

Monatsschr Kinderheilkd

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Zusammenfassung Die antibiotische Therapie stellt eine wichtige und in vielen Fällen unverzichtbare Maßnahme zum Erreichen einer Restitutio ad integrum bei bakteriellen Infektionen dar. Hierdurch können auch schwere Infektionen bei immungeschwächten Patienten geheilt werden. Wir wissen heute aber auch, dass insbesondere kritisch kranke Kinder häufig inadäquat antibiotisch behandelt werden – mit ebenfalls potenziell schädlichen Nebenwirkungen. In diesem Spannungsfeld aus kritisch krankem Kind, der Angst, etwas zu verpassen, und potenzieller Übertherapie ist es oft nicht einfach, eine rationale Therapieentscheidung zu fällen. Im vorliegenden Review werden aktuelle Studien zu wichtigen Aspekten der antibiotischen Therapie bei kritisch kranken Kindern beleuchtet und im Hinblick auf klinische Umsetzbarkeit interpretiert. Folgende Teilaspekte werden besprochen: 1) Zeitpunkt der antibiotischen Therapie und Möglichkeiten eines abwartenden Verhaltens, 2) die Auswahl der Antibiotika in der empirischen Therapie, 3) Deeskalationsstrategien und 4) die Dauer der antibiotischen Therapie. Antibiotic-Stewardship-Programme, unter Einbeziehung von pädiatrischen Infektiologen, klinischen Pharmazeuten und Mikrobiologen, spielen bei den häufig schwierigen klinischen Entscheidungen eine entscheidende Rolle.

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Abstract: The use of β-lactam monotherapy for gram-negative bacteremia in pediatric patients reduces subsequent nephrotoxicity without compromising survival.

Cited by 40 publications

References 62 publications

Antimicrobial Renal Injury in a Pediatric Intensive Care Unit: β-Lactams vs. Vancomycin

Antimicrobial Renal Injury in a Pediatric Intensive Care Unit: β-Lactams vs. Vancomycin

Neuroanesthesia and Coexisting Renal Problems

Antibiotische Therapie bei kritisch kranken Kindern – Ist weniger mehr?

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