Association of antibiotic use and acute kidney injury in patients hospitalized with community-acquired pneumonia

Abstract

Background

Acute kidney injury (AKI) is common among hospitalized patients with community-acquired pneumonia (CAP). We aimed to estimate and compare the risk of AKI for various antibiotic combinations in adults hospitalized for CAP.

Methods

We conducted a retrospective cohort study of the Premier Healthcare Database containing all admissions for 660 US hospitals from 2010 to 2015. We included adults aged ≥18 years hospitalized with CAP and considered 6 different antibiotic combinations based on continuous use in the first 3 hospital days. The primary outcome was incident AKI, defined by ICD-9 codes 584.5-584-9. We evaluated associations of AKI with in-hospital mortality and length-of-stay. We excluded patients who were admitted directly to the intensive care unit, had AKI codes present on admission or had dialysis in the first 2 days. We used generalized linear mixed models with the hospital as a random effect and covariate adjustment for patient demographics, comorbidities, other treatments on day 0/1, and hospital characteristics.

Results

The total sample included 449,535 patients, 3.15% of whom developed AKI. All other regimens but fluoroquinolones exhibited higher AKI odds than 3rd generation cephalosporin with or without macrolide. The combination of piperacillin/tazobactam and vancomycin with or without other antibiotics was associated with the highest AKI odds (OR = 1.89; 95% CI: 1.73–2.06). Patients with incident AKI had an increased odds of hospital mortality (OR = 6.37; 95% CI: 6.07–6.69) and longer length-of-stay (mean multiplier = 1.84; 95% CI: 1.82, 1.86).

Conclusion

Compared to 3rd generation cephalosporin with or without macrolide, piperacillin/tazobactam, vancomycin, and their combination were associated with higher odds of developing AKI, which in turn were associated with worse clinical outcomes.

Keywords:

• Acute kidney injury community-acquired pneumonia
• antibiotics
• epidemiology

Transparency

Declaration of funding

This work was supported by AHRQ under Grant #R01HS24277 (Michael B. Rothberg). The funder had no role in the preparation of this article.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Phuc Le: Conceptualization, Methodology, Writing – original draft; Sankar Dass Navaneethan: Methodology, Writing – review & editing; Pei-Chun Yu: Data curation, Formal analysis; Andrea M. Pallotta, Writing – review & editing; Preethi Patel, Writing – review & editing; Andrei Brateanu, Writing – review & editing; Radhika Rastogi, Writing – review & editing; Peter B. Imrey: Methodology, Formal analysis; Michael B. Rothberg: Conceptualization, Funding acquisition, Supervision, Writing – review & editing.

Acknowledgements

No assistance in the preparation of this article is to be declared. A preliminary data of this paper were presented at the Society of General Internal Medicine Annual Meeting in 2019.

Data availability statement

Our paper used the Premier Healthcare database which belongs to the Premier Inc. Interested parties should contact the Premier Inc. to query about data access.