Risk Factors for Nephrotoxicity in Methicillin-Resistant Staphylococcus aureus Bacteraemia: A Post Hoc Analysis of the CAMERA2 Trial.
Humans
Acute Kidney Injury
/ chemically induced
Anti-Bacterial Agents
/ adverse effects
Bacteremia
/ drug therapy
beta-Lactams
/ adverse effects
Cefazolin
/ therapeutic use
Cloxacillin
/ therapeutic use
Drug-Related Side Effects and Adverse Reactions
Methicillin-Resistant Staphylococcus aureus
Prospective Studies
Retrospective Studies
Risk Factors
Staphylococcal Infections
/ drug therapy
Staphylococcus aureus
Vancomycin
/ adverse effects
Journal
Clinical drug investigation
ISSN: 1179-1918
Titre abrégé: Clin Drug Investig
Pays: New Zealand
ID NLM: 9504817
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
accepted:
13
09
2022
pubmed:
11
10
2022
medline:
14
1
2023
entrez:
10
10
2022
Statut:
ppublish
Résumé
Clinical risk factors for nephrotoxicity in Staphylococcus aureus bacteraemia remain largely undetermined, despite its common occurrence and clinical significance. In an international, multicentre, prospective clinical trial (CAMERA2), which compared standard therapy (vancomycin monotherapy) to combination therapy (adding an anti-staphylococcal beta-lactam) for methicillin-resistant S. aureus bacteraemia, significantly more people in the combination therapy arm experienced acute kidney injury compared with those in the monotherapy arm (23% vs 6%). The aim of this post hoc analysis was to explore in greater depth the risk factors for acute kidney injury from the CAMERA2 trial. Among participants of the CAMERA2 trial, demographic-related, infection-related and treatment-related risk factors were assessed for their relationship with acute kidney injury by univariable and multivariable logistic regression. Acute kidney injury was defined by a modified-KDIGO (Kidney Disease: Improving Global Outcomes) criteria (not including urinary output). Of the 266 participants included, age (p = 0.04), randomisation to combination therapy (p = 0.002), vancomycin area under the concentration-time curve (p = 0.03) and receipt of (flu)cloxacillin as the companion beta-lactam (p < 0.001) were significantly associated with acute kidney injury. On a multivariable analysis, concurrent use of (flu)cloxacillin increased the risk of acute kidney injury over four times compared with the use of cefazolin or no beta-lactam. The association of vancomycin area under the concentration-time curve with acute kidney injury also persisted in the multivariable model. For participants receiving vancomycin for S. aureus bacteraemia, use of (flu)cloxacillin and increased vancomycin area under the concentration-time curve were risk factors for acute kidney injury. These represent potentially modifiable risk factors for nephrotoxicity and highlight the importance of avoiding the use of concurrent nephrotoxins.
Sections du résumé
BACKGROUND
BACKGROUND
Clinical risk factors for nephrotoxicity in Staphylococcus aureus bacteraemia remain largely undetermined, despite its common occurrence and clinical significance. In an international, multicentre, prospective clinical trial (CAMERA2), which compared standard therapy (vancomycin monotherapy) to combination therapy (adding an anti-staphylococcal beta-lactam) for methicillin-resistant S. aureus bacteraemia, significantly more people in the combination therapy arm experienced acute kidney injury compared with those in the monotherapy arm (23% vs 6%).
OBJECTIVE
OBJECTIVE
The aim of this post hoc analysis was to explore in greater depth the risk factors for acute kidney injury from the CAMERA2 trial.
METHODS
METHODS
Among participants of the CAMERA2 trial, demographic-related, infection-related and treatment-related risk factors were assessed for their relationship with acute kidney injury by univariable and multivariable logistic regression. Acute kidney injury was defined by a modified-KDIGO (Kidney Disease: Improving Global Outcomes) criteria (not including urinary output).
RESULTS
RESULTS
Of the 266 participants included, age (p = 0.04), randomisation to combination therapy (p = 0.002), vancomycin area under the concentration-time curve (p = 0.03) and receipt of (flu)cloxacillin as the companion beta-lactam (p < 0.001) were significantly associated with acute kidney injury. On a multivariable analysis, concurrent use of (flu)cloxacillin increased the risk of acute kidney injury over four times compared with the use of cefazolin or no beta-lactam. The association of vancomycin area under the concentration-time curve with acute kidney injury also persisted in the multivariable model.
CONCLUSIONS
CONCLUSIONS
For participants receiving vancomycin for S. aureus bacteraemia, use of (flu)cloxacillin and increased vancomycin area under the concentration-time curve were risk factors for acute kidney injury. These represent potentially modifiable risk factors for nephrotoxicity and highlight the importance of avoiding the use of concurrent nephrotoxins.
Identifiants
pubmed: 36217068
doi: 10.1007/s40261-022-01204-z
pii: 10.1007/s40261-022-01204-z
pmc: PMC9834357
doi:
Substances chimiques
Anti-Bacterial Agents
0
beta-Lactams
0
Cefazolin
IHS69L0Y4T
Cloxacillin
O6X5QGC2VB
Vancomycin
6Q205EH1VU
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
23-33Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2022. Crown.
Références
Crit Care Med. 2006 Oct;34(10):2588-95
pubmed: 16915117
Nephrol Dial Transplant. 1995;10(4):579
pubmed: 7624012
Clin Infect Dis. 2021 Dec 16;73(12):2353-2360
pubmed: 33993226
Ann Intern Med. 1980 Nov;93(5):735-41
pubmed: 7212486
Arch Intern Med. 2002 Oct 28;162(19):2229-35
pubmed: 12390067
Eur J Clin Pharmacol. 2012 Sep;68(9):1243-55
pubmed: 22411630
Clin Infect Dis. 2020 Sep 12;71(6):1361-1364
pubmed: 32658968
Ann Clin Microbiol Antimicrob. 2016 Feb 09;15:7
pubmed: 26860463
Clin Kidney J. 2020 May 17;14(4):1114-1119
pubmed: 33841856
Clin Infect Dis. 2020 Jul 11;71(2):426-432
pubmed: 31833540
Crit Care. 2004 Aug;8(4):R204-12
pubmed: 15312219
Nephrol Dial Transplant. 2013 Mar;28(3):612-9
pubmed: 23197677
Clin Microbiol Infect. 2020 Jun;26(6):696-705
pubmed: 32222460
Ann Pharmacother. 2018 Jul;52(7):639-644
pubmed: 29442542
Clin J Am Soc Nephrol. 2017 Dec 7;12(12):2046-2049
pubmed: 28893923
Clin Infect Dis. 2016 Jan 15;62(2):173-180
pubmed: 26349552
Kidney Int Rep. 2020 Apr 20;5(7):1068-1070
pubmed: 32647765
Antimicrob Agents Chemother. 2011 Jul;55(7):3278-83
pubmed: 21576448
MMWR Morb Mortal Wkly Rep. 2019 Mar 08;68(9):214-219
pubmed: 30845118
Crit Care Med. 2018 Jan;46(1):12-20
pubmed: 29088001
J Clin Microbiol. 2022 Apr 20;60(4):e0242921
pubmed: 35254101
J Am Soc Nephrol. 2004 Jun;15(6):1597-605
pubmed: 15153571
Clin Infect Dis. 2017 Nov 29;65(12):2137-2143
pubmed: 29020249
Crit Care. 2013 Feb 04;17(1):204
pubmed: 23394211
Antimicrob Agents Chemother. 2021 Sep 17;65(10):e0106021
pubmed: 34339278
Clin Microbiol Rev. 2015 Jul;28(3):603-61
pubmed: 26016486
Clin Infect Dis. 2019 Nov 13;69(11):1881-1887
pubmed: 30715208
Infez Med. 2019 Dec 1;27(4):380-392
pubmed: 31846987
Aust Fam Physician. 2008 Dec;37(12):1009-11
pubmed: 19142275
Am J Nephrol. 2021;52(2):85-97
pubmed: 33735856
Antimicrob Agents Chemother. 2016 Sep 23;60(10):5742-51
pubmed: 27431226
Crit Care Med. 2009 Sep;37(9):2552-8
pubmed: 19602973
JAMA. 2020 Feb 11;323(6):527-537
pubmed: 32044943
J Antimicrob Chemother. 2013 May;68(5):1179-82
pubmed: 23302579
Drug Metab Dispos. 2013 Apr;41(4):791-800
pubmed: 23344796
Antimicrob Agents Chemother. 2013 Feb;57(2):734-44
pubmed: 23165462
Clin Microbiol Rev. 2012 Apr;25(2):362-86
pubmed: 22491776
J Antimicrob Chemother. 2019 Aug 1;74(8):2326-2334
pubmed: 31065686
Lancet Infect Dis. 2011 Mar;11(3):208-22
pubmed: 21371655
BMC Infect Dis. 2012 Apr 27;12:104
pubmed: 22540223
Intensive Care Med. 1996 Jul;22(7):707-10
pubmed: 8844239
Swiss Med Wkly. 2017 Aug 14;147:w14482
pubmed: 28804865
J Antimicrob Chemother. 2014 Mar;69(3):805-8
pubmed: 24107387
Am J Health Syst Pharm. 2021 Nov 23;78(23):2116-2125
pubmed: 34125896
Open Forum Infect Dis. 2020 Nov 04;7(12):ofaa538
pubmed: 33335938
Trials. 2016 Mar 31;17:170
pubmed: 27029920
Clin J Am Soc Nephrol. 2020 Mar 6;15(3):423-429
pubmed: 32075806
Clin Infect Dis. 2020 Apr 10;70(8):1536-1545
pubmed: 31157370
J Hosp Infect. 2013 Apr;83(4):300-6
pubmed: 23369468
J Nephrol. 2021 Dec;34(6):1941-1948
pubmed: 33515381
J Clin Epidemiol. 1994 Nov;47(11):1245-51
pubmed: 7722560