Table 1.
Comparison of Baseline Characteristics Between Patients by Day 2 Area Under the Curve Categories and Presence and Absence of Vancomycin-Associated Acute Kidney Injury Outcomes
| Characteristic | AUC <400 (n = 48) |
AUC 400–600 (n = 81) |
AUC >600 (n = 101) |
KDIGO (n = 73) |
No KDIGO (n = 157) | RIFLE (n = 55) |
No RIFLE (n = 175) |
KDIGO Stage II/RIFLE Injury (n = 30) | No KDIGO Stage II/RIFLE Injury (n = 200) | KDIGO Stage III/RIFLE Failure (n = 14) | No KDIGO Stage III/RIFLE Failure (n = 216) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Male sex | 29 (60.4) | 48 (59.3) | 68 (67.3) | 47 (64.4) | 98 (62.4) | 34 (61.8) | 111 (63.4) | 14 (46.7)a | 131 (65.5) | 9 (64.3) | 136 (63.0) |
| White race | 30 (62.5) | 56 (69.1) | 67 (66.3) | 45 (61.6) | 108 (68.8) | 32 (58.2)b | 121 (69.1) | 17 (56.7) | 136 (68.0) | 10 (71.4) | 143 (66.2) |
| Weight, kg, mean (SD) | 76.5 (21.4)a | 78.3 (22.4) | 89.8 (27.0) | 82.7 (23.2) | 83.1 (25.9) | 81.8 (22.9) | 83.4 (25.6) | 75.9 (21.2)b | 84.0 (25.4) | 78.9 (21.7) | 83.3 (25.2) |
| Body mass index, mean (SD) | 26.8 (6.3)a | 26.2 (6.3) | 30.1 (9.1) | 28.0 (7.4) | 28.0 (8.0) | 28.0 (7.7) | 28.0 (7.9) | 26.8 (7.6) | 28.2 (7.9) | 27.2 (6.2) | 28.1 (7.9) |
| Age, years, mean (SD) | 57.0 (18.6)b | 62.2 (16.0) | 57.2 (15.9) | 63.0 (14.3) | 57.0 (17.3) | 62.0 (14.0)b | 58.0 (17.3) | 60.9 (14.8) | 58.7 (16.9) | 56.9 (13.4)b | 59.1 (16.8) |
| Residence in ICU at time of index blood culture collection | 7 (14.6) | 17 (21.0) | 24 (23.8) | 17 (23.3) | 31 (19.7) | 13 (23.6) | 35 (20.0) | 6 (20.0) | 42 (21.0) | 3 (21.4) | 45 (20.8) |
| Type of MRSA: hospital/healthcare acquired | 30 (62.5)b | 55 (67.9) | 79 (78.2) | 55 (75.3) | 109 (69.4) | 43 (78.2)b | 121 (69.1) | 24 (80.0) | 140 (70.0) | 11 (78.6) | 153 (70.8) |
| Residence in healthcare institution for >72 hours in past 180 days | 22 (45.8)a | 39 (48.1) | 66 (65.4) | 39 (53.4) | 88 (56.1) | 28 (50.9) | 99 (56.6) | 15 (50.0) | 112 (56.0) | 7 (50.0) | 120 (55.6) |
| Length of hospital stay, days, prior to index culture, median (IQR) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–0) |
| APACHE II score, mean (SD) | 9.8 (5.0)a | 11.9 (5.0) | 11.9 (5.4) | 11.8 (5.6) | 11.3 (5.1) | 11.4 (5.7) | 11.5 (5.1) | 11.4 (5.8) | 11.5 (5.2) | 12.9 (7.5) | 11.4 (5.1) |
| Estimated creatinine clearance at baseline, mL/min, mean (SD) | 94.5 (46.1) | 88.0 (49.0) | 99.4 (62.2) | 94.1 (61.3) | 94.5 (51.5) | 103.6 (65.6) | 91.4 (50.0) | 110.3 (77.9)b | 92.0 (50.1) | 129.8 (108.1)b | 92.1 (48.9) |
| Diabetes mellitus | 12 (25.0)b | 24 (29.6) | 41 (40.6) | 25 (34.2) | 52 (33.1) | 18 (32.7) | 59 (33.7) | 10 (33.3) | 67 (33.5) | 5 (35.7) | 72 (33.3) |
| Heart failure (class II–IV) | 3 (6.3) | 10 (12.3) | 10 (9.9) | 5 (6.8) | 18 (11.5) | 1 (1.8)a | 22 (12.6) | 0 (0.0)b | 23 (11.5) | 0 (0)b | 23 (10.6) |
| COPD | 5 (10.4)b | 17 (21.0) | 16 (15.8) | 12 (16.4) | 26 (16.6) | 5 (9.1)b | 33 (18.9) | 0 (0)a | 38 (19.0) | 0 (0)b | 38 (17.6) |
| Transplanted organ | 3 (6.3) | 5 (6.2) | 4 (4.0) | 3 (4.1) | 9 (5.7) | 2 (3.6) | 10 (5.7) | 2 (6.7) | 10 (5.0) | 0 (0) | 12 (5.6) |
| Active malignancy | 9 (18.8) | 14 (17.3) | 15 (14.9) | 13 (17.8) | 25 (15.9) | 9 (16.4) | 29 (16.6) | 3 (10.0) | 35 (17.5) | 0 (0)b | 38 (17.6) |
| Receipt of immunosuppressive drugs in last 30 days | 11 (22.9) | 12 (14.9) | 15 (14.9) | 8 (11.0)b | 30 (19.1) | 7 (12.7) | 31 (17.7) | 2 (6.7)b | 36 (18.0) | 0 (0)b | 38 (17.6) |
| Decubitus ulcers (stage II–IV) | 5 (10.4) | 6 (7.4) | 15 (14.9) | 4 (5.5)b | 22 (14.0) | 4 (7.7) | 22 (12.6) | 0 (0)a | 26 (13.0) | 0 (0)b | 26 (12.0) |
| Cerebrovascular accident | 7 (14.6) | 6 (7.4) | 12 (11.9) | 6 (8.2) | 19 (12.1) | 3 (5.5)b | 22 (12.6) | 0 (0)a | 25 (12.5) | 0 (0)b | 25 (11.6) |
| Surgery requiring >48 hours hospitalization in 30 days prior to date of index culture | 5 (10.4) | 8 (9.9) | 16 (15.8) | 12 (16.4) | 17 (10.8) | 10 (18.2)b | 19 (10.9) | 7 (23.3)b | 22 (11.0) | 3 (21.4) | 26 (12.0) |
| Presence of infective endocarditis | 12 (25.0) | 21 (25.9) | 32 (31.7) | 24 (32.9) | 41 (26.1) | 16 (29.1) | 49 (28.0) | 7 (23.3) | 58 (29.0) | 4 (28.6) | 61 (28.2) |
| Preexisting valvular heart disease | 5 (10.4) | 11 (13.6) | 9 (8.9) | 4 (5.5)b | 21 (13.4) | 3 (5.5)b | 22 (12.6) | 2 (6.7) | 23 (11.5) | 1 (7.1) | 24 (11.1) |
| Previous infective endocarditis | 1 (2.1) | 1 (1.2) | 4 (4.0) | 1 (1.4) | 5 (3.2) | 0 (0)b | 6 (3.4) | 0 (0) | 6 (3.0) | 0 (0) | 6 (2.8) |
| Cardiac prosthetic device (eg, pacemaker, cardioverter-defibrillator, prosthetic valve) | 3 (6.3) | 5 (6.2) | 10 (9.9) | 4 (5.5) | 14 (8.9) | 2 (3.6)b | 16 (9.1) | 0 (0)b | 18 (9.0) | 0 (0) | 18 (8.3) |
| Prosthetic joints | 5 (10.4) | 5 (6.2) | 6 (5.9) | 5 (6.8) | 11 (7.0) | 2 (3.6) | 14 (8.0) | 0 (0)b | 16 (8.0) | 0 (0) | 16 (7.4) |
| Intravascular prosthetic material (eg, grafts, stents) | 6 (12.5) | 9 (11.1) | 12 (11.9) | 11 (15.1) | 16 (10.2) | 7 (12.7) | 20 (11.4) | 3 (10.0) | 24 (12.0) | 0 (0)b | 27 (12.5) |
| Receipt of antibiotic for at least 48 hours in the 30 days prior to index culture | 13 (27.1) | 31 (38.3) | 40 (39.6) | 22 (30.1)b | 62 (39.5) | 16 (29.1)b | 68 (38.9) | 8 (26.7) | 76 (38.0) | 3 (21.4) | 81 (37.5) |
| Receipt of vancomycin ≥48 hours in 30 days prior to index culture | 2 (4.2) | 9 (11.1) | 13 (12.9) | 11 (15.1)b | 13 (8.1) | 8 (14.5) | 16 (9.1) | 4 (13.3) | 20 (10.0) | 2 (14.3) | 22 (10.2) |
| Polymicrobial BSI | 2 (4.2) | 5 (6.2) | 11 (10.9) | 7 (9.6) | 11 (7.0) | 4 (7.3) | 14 (8.0) | 3 (10.0) | 15 (7.5) | 0 (0) | 18 (8.3) |
| Source of bacteremia infection–possibly to definitely | |||||||||||
| Intravenous catheter | 12 (25.0) | 20 (24.7) | 34 (33.7) | 24 (32.9) | 42 (26.8) | 20 (36.4)b | 46 (26.3) | 12 (40.0)b | 54 (27.0) | 4 (28.6) | 62 (28.7) |
| Urinary tract | 6 (12.5) | 9 (11.1) | 16 (15.8) | 6 (8.2)b | 25 (15.9) | 5 (9.1) | 26 (14.9) | 3 (10.0) | 28 (14.0) | 2 (14.3) | 29 (13.4) |
| Osteoarticular (bone and joint) | 8 (16.7) | 16 (19.8) | 16 (15.8) | 12 (16.4) | 28 (17.8) | 6 (10.9)b | 34 (19.4) | 2 (6.7)b | 38 (19.0) | 2 (14.3) | 38 (17.6) |
| Skin and soft tissue | 26 (54.2) | 39 (48.1) | 42 (41.6) | 34 (46.6) | 73 (46.5) | 29 (52.7) | 78 (44.6) | 18 (60.0)b | 89 (44.5) | 6 (42.9) | 101 (46.8) |
| Abdominal source | 5 (10.4) | 5 (6.2) | 8 (7.9) | 7 (9.6) | 11 (7.0) | 7 (12.7)b | 11 (6.3) | 4 (13.3) | 14 (7.0) | 2 (14.3) | 16 (7.4) |
| Central nervous system | 1 (2.1) | 4 (4.9) | 2 (2.0) | 2 (2.7) | 5 (3.2) | 1 (1.8) | 6 (3.4) | 1 (3.3) | 6 (3.0) | 0 (0) | 7 (3.2) |
| Respiratory tract | 4 (8.3)b | 15 (18.5) | 22 (21.8) | 14 (19.2) | 27 (17.2) | 11 (20.0) | 30 (17.1) | 9 (30.0)b | 32 (16.0) | 5 (25.7)b | 36 (16.7) |
| Other | 7 (14.6) | 12 (14.8) | 19 (18.8) | 11 (15.1) | 27 (17.2) | 6 (10.9)b | 32 (18.3) | 4 (13.3) | 34 (17.0) | 3 (21.4) | 35 (16.2) |
| Receipt of β-lactam during first 7 days of vancomycin >24 hours | 25 (52.1) | 41 (50.6) | 62 (61.4) | 44 (60.3) | 84 (53.5) | 32 (58.2) | 96 (54.9) | 14 (46.7) | 114 (57.0) | 6 (42.9) | 122 (56.5) |
| Receipt of aminoglycoside during first 7 days of vancomycin >24 hours | 1 (2.1) | 3 (3.7) | 4 (4.0) | 4 (5.5) | 4 (2.5) | 4 (7.3)b | 4 (2.3) | 4 (13.3)a | 4 (2.0) | 3 (21.4)a | 5 (2.3) |
| Receipt of clindamycin during first 7 days of vancomycin >24 hours | 1 (2.1) | 3 (3.7) | 4 (4.0) | 3 (4.1) | 5 (3.2) | 3 (5.5) | 5 (2.9) | 2 (6.7) | 6 (3.0) | 2 (14.3)a | 6 (2.8) |
| Receipt of fluoroquinolone during first 7 days of vancomycin >24 hours | 2 (4.2) | 5 (6.2) | 7 (6.9) | 8 (11.0)a | 6 (3.8) | 6 (10.9)b | 8 (4.6) | 4 (13.3)b | 10 (5.0) | 4 (28.6)a | 10 (4.6) |
| Receipt of rifampin during first 7 days >24 hours | 0 (0) | 4 (4.9) | 5 (5.0) | 5 (6.8)b | 4 (2.5) | 3 (5.5) | 6 (3.4) | 1 (3.3) | 8 (4.0) | 1 (7.1) | 8 (3.7) |
| Duration of vancomycin, median (IQR) | 11.0 (7.25–22.25) | 15.0 (8.5–24.0) | 14.0 (0.0–29.5) | 15.0 (9.0–28.0)b | 13.0 (7.0–24.5) | 15.0 (9.0–20.0) | 14.0 (7.0–28.0) | 14.5 (9.0–25.0) | 14.0 (7.0–25.75) | 12.5 (7.0–24.75) | 14.5 (8.0–25.75) |
Data are presented as No. (%), unless otherwise indicated.
Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; AUC, area under the curve; BSI, bloodstream infection; COPD, chronic obstructive pulmonary disease; KDIGO, Kidney Disease: Improving Global Outcomes; ICU, intensive care unit; IQR, interquartile range; MRSA, methicillin-resistant Staphylococcus aureus; RIFLE, modified Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease; SD, standard deviation.
P < .05.
P < .2.