Scholarly record

ANTIBIOTIC- INDUCED ACUTE KIDNEY INJURY: A SINGLE-CENTER EXPERIENCE

Magda Petrescu, Andreea Grosu, Anamaria Trandafir, Liliana A. Tuta, Camelia Pana

Abstract

Antibiotics represent one of the most used classes of medications since the discovery of penicillin by Alexander Fleming in 1928. A significant percentage of antibiotics and their metabolites are excreted in the urine, leading to a high concentration in the kidney that may often cause renal impairment. Medication-induced nephrotoxicity represents one of the most common causes of acute kidney injury (AKI) in hospitalized patients. Clinical manifestations are variable, ranging from mild to severe forms, requiring renal replacement therapy. Methods: We conducted a retrospective study on 122 patients admitted for antibiotics' associated acute kidney injury in our county clinical emergency hospital for the interval of time of one year. We have collected patients' demographic data, history of past and current medications and diseases, biological parameters and imagistic data. Drug-induced AKI was defined considering AKIN classification. Results: From the 122 admitted patients (42 men and 80 women). Aminoglycosides (gentamicin and amikacin), vancomycin, beta-lactam antibiotics (ceftriaxone and cefuroxime), usually monotherapy and rarely in combination therapy were the constant causes of AKI. The most frequent co-morbidities in our study group were: diabetes mellitus (35.2%), renal lithiasis (32%) and arterial hypertension (20.5%). Presence of diabetes mellitus as comorbidity (OR=2.8; CI=1.5-5.9, P=0.01), administration of nephrotoxic combinations, (OR=1.9; CI=1.1-3.8, P=0.04) and moderate-to-severe dehydration syndrome on admission (OR=3.8; CI=2.1 -6.8, P<0.001), were discovered to be independent risk factors for AKI due to antibiotic administration in our study group. Renal replacement therapy was needed in 17.2% of our patients, and 11.4% died in spite of intensive therapy. Conclusions: By living in the era of highly resistant pathogens and patients with multiple comorbidities, antibiotics represent important allies to healthcare workers, with the condition of optimal prescription and use. Also, several strategies may help prevent medication-induced acute kidney injury, especially in patients that are highly susceptible: dosage adjustment to the renal dysfunction, adequate hydration during the therapy, avoidance of concomitant use of other nephrotoxic drugs such as non-steroidal anti-inflammatory drugs, renin- angiotensin-aldosterone inhibitors or contrast media.

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