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      A Multicenter Evaluation of Vancomycin-Associated Acute Kidney Injury in Hospitalized Patients with Acute Bacterial Skin and Skin Structure Infections

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          Abstract

          Background

          We sought to determine the real-world incidence of and risk factors for vancomycin-associated acute kidney injury (V-AKI) in hospitalized adults with acute bacterial skin and skin structure infections (ABSSSI).

          Methods

          Retrospective, observational, cohort study at ten U.S. medical centers between 2015 and 2019. Hospitalized patients treated with vancomycin (≥ 72 h) for ABSSSI and ≥ one baseline AKI risk factor were eligible. Patients with end-stage kidney disease, on renal replacement therapy or AKI at baseline, were excluded. The primary outcome was V-AKI by the vancomycin guidelines criteria.

          Results

          In total, 415 patients were included. V-AKI occurred in 39 (9.4%) patients. Independent risk factors for V-AKI were: chronic alcohol abuse (aOR 4.710, 95% CI 1.929–11.499), no medical insurance (aOR 3.451, 95% CI 1.310–9.090), ICU residence (aOR 4.398, 95% CI 1.676–11.541), Gram-negative coverage (aOR 2.926, 95% CI 1.158–7.392) and vancomycin duration (aOR 1.143, 95% CI 1.037–1.260). Based on infection severity and comorbidities, 34.7% of patients were candidates for oral antibiotics at baseline and 39.3% had non-purulent cellulitis which could have been more appropriately treated with a beta-lactam. Patients with V-AKI had significantly longer hospital lengths of stay (9 vs. 6 days, p = 0.001), higher 30-day readmission rates (30.8 vs. 9.0%, p < 0.001) and increased all-cause 30-day mortality (5.1 vs. 0.3%, p = 0.024)

          Conclusions

          V-AKI occurred in approximately one in ten ABSSSI patients and may be largely prevented by preferential use of oral antibiotics whenever possible, using beta-lactams for non-purulent cellulitis and limiting durations of vancomycin therapy.

          Electronic supplementary material

          The online version of this article (10.1007/s40121-019-00278-1) contains supplementary material, which is available to authorized users.

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          Most cited references 63

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          Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.

          Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.
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            A new equation to estimate glomerular filtration rate.

            Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values. To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates. Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006. 8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16,032 participants in NHANES. GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age. In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%). The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR. The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use. National Institute of Diabetes and Digestive and Kidney Diseases.
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              A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

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                Author and article information

                Contributors
                m.rybak@wayne.edu
                Journal
                Infect Dis Ther
                Infect Dis Ther
                Infectious Diseases and Therapy
                Springer Healthcare (Cheshire )
                2193-8229
                2193-6382
                25 January 2020
                25 January 2020
                March 2020
                : 9
                : 1
                : 89-106
                Affiliations
                [1 ]GRID grid.254444.7, ISNI 0000 0001 1456 7807, Eugene Applebaum College of Pharmacy & Health Sciences, , Wayne State University, ; Detroit, MI USA
                [2 ]GRID grid.413184.b, ISNI 0000 0001 0088 6903, Detroit Medical Center, ; Detroit, MI USA
                [3 ]GRID grid.256969.7, ISNI 0000 0000 9902 8484, Fred Wilson School of Pharmacy, , High Point University, ; High Point, NC USA
                [4 ]GRID grid.416125.5, Cone Health, ; Greensboro, NC USA
                [5 ]GRID grid.239424.a, ISNI 0000 0001 2183 6745, Boston Medical Center, ; Boston, MA USA
                [6 ]GRID grid.416306.6, ISNI 0000 0001 0679 2430, Maimonides Medical Center, ; Brooklyn, NY USA
                [7 ]GRID grid.214458.e, ISNI 0000000086837370, University of Michigan, ; Ann Arbor, MI USA
                [8 ]GRID grid.416010.2, ISNI 0000 0000 9887 0186, Guthrie Robert Packer Hospital, ; Sayre, PA USA
                [9 ]GRID grid.417170.4, ISNI 0000 0004 0429 5571, Parkland Memorial Hospital, ; Dallas, TX USA
                [10 ]GRID grid.411461.7, ISNI 0000 0001 2315 1184, College of Pharmacy, , University of Tennessee Health Sciences Center, ; Knoxville, TN USA
                [11 ]GRID grid.241128.c, ISNI 0000 0004 0435 2118, University of Tennessee Medical Center, ; Knoxville, TN USA
                [12 ]GRID grid.414639.d, ISNI 0000 0004 0451 9467, The Brooklyn Hospital Center, ; Brooklyn, NY USA
                [13 ]GRID grid.476515.4, Motif BioSciences, ; Princeton, NJ USA
                [14 ]GRID grid.430387.b, ISNI 0000 0004 1936 8796, Rutgers New Jersey Medical School, ; Trenton, NJ USA
                [15 ]GRID grid.239864.2, ISNI 0000 0000 8523 7701, Henry Ford Health-System, ; Detroit, MI USA
                [16 ]GRID grid.254444.7, ISNI 0000 0001 1456 7807, School of Medicine, , Wayne State University, ; Detroit, MI USA
                Article
                278
                10.1007/s40121-019-00278-1
                7054514
                31983021
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                Funding
                Funded by: Motif
                Categories
                Original Research
                Custom metadata
                © The Author(s) 2020

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