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Impact of decreasing vancomycin exposure on acute kidney injury in stem cell transplant recipients

Published online by Cambridge University Press:  07 December 2021

Horace Rhodes Hambrick Open the ORCID record for Horace Rhodes Hambrick [Opens in a new window] ,
Kimberly F. Greco ,
Edie Weller ,
Lakshmi Ganapathi ,
Leslie E. Lehmann  and
Thomas J. Sandora Open the ORCID record for Thomas J. Sandora [Opens in a new window]
Horace Rhodes Hambrick*
Affiliation:
Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts Department of Pediatric Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Kimberly F. Greco
Affiliation:
Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts
Edie Weller
Affiliation:
Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
Lakshmi Ganapathi
Affiliation:
Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts Division of Nephrology, Boston Children’s Hospital, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
Leslie E. Lehmann
Affiliation:
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts Pediatric Stem Cell Transplant, Dana-Farber Cancer Institute, Boston, Massachusetts
Thomas J. Sandora
Affiliation:
Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
*
Author for correspondence: Horace Rhodes Hambrick, E-mail: [email protected]
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Abstract

Objective:

To evaluate the change in vancomycin days of therapy (DOT) and vancomycin-associated acute kidney injury (AKI) after an antimicrobial stewardship program (ASP) intervention to decrease vancomycin use in stable patients after hematopoietic stem cell transplantation (HSCT).

Design:

Retrospective cohort study and quasi-experimental interrupted time series analysis. Change in unit-level vancomycin DOT per 1,000 inpatient days after the intervention was assessed using segmented Poisson regression. Subject-specific risk of vancomycin-associated AKI was evaluated using a random intercept logistic regression model with mediation analysis.

Setting:

HSCT unit at a single quaternary-care pediatric hospital.

Participants:

Inpatients aged 3 months and older who underwent HSCT between January 1, 2015, and March 31, 2019 (27 months before and after the intervention) who received any dose of vancomycin.

Intervention:

An ASP intervention in April 2017 creating a new practice guideline to decrease prolonged (>72 hours) vancomycin courses for stable HSCT patients with febrile neutropenia.

Results:

Overall, 439 vancomycin exposures (234 before the intervention and 205 after the intervention) occurring across 300 transplants and 259 subjects were included. The mean vancomycin DOT was 307 per 1,000 inpatient days (95% confidence interval [CI], 272–342) and decreased after the intervention to 207 per 1,000 inpatient days (95% CI, 173–240). In multivariable analyses, the odds of AKI in the postintervention period were 37% lower than in the preintervention period (adjusted OR, 0.63; 95% CI, 0.42–0.95; P = .0268); 56% of the excess risk was mediated by vancomycin DOT.

Conclusions:

An ASP intervention successfully decreased vancomycin use after HSCT and resulted in a decrease in AKI. Reducing empiric antibiotic exposure for stable patients after HSCT can improve clinical outcomes.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 10 , October 2022 , pp. 1375 - 1381
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. This work was presented in a poster session at the May 2021 meeting of the Pediatric Academic Societies, held virtually.

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