amoxicillin-potassium-clavulanate-combination and Acute-Kidney-Injury

Leptospirosis is an anthropozoonose, an animal disease transmissible to humans, caused by a spirochete of the genus Leptospira that lives mainly among rodents but also in wetlands. It occurs worldwide, particularly in Asia, Latin America and Africa. In Europe, the incidence is small (except in France and Great Britain, where its frequency has increased in recent years) but the frequency may be underestimated. Some areas overseas are particularly affected. In France, the potential epidemic of leptospirosis is subject to climatic variations, justifying a constant monitoring of the disease provided by the National Reference Centre (CNR) of leptospires. Transmission to humans primarily occurs through contact with environments contaminated by the urine of infected animals. The disease can affect the liver and kidneys (hepatonephritis) as cytolysis, cholestasis and renal failure associated with fever. A coagulopathy usually accompanies the clinical table. Its diagnosis is difficult because of the clinical polymorphism. Early diagnosis of leptospirosis allows effective medical care, improving patient outcomes. This is currently based on gene amplification (PCR) or serology positive by the microscopic agglutination test (MAT), which is the reference method. Its evolution is usually favorable with appropriate antibiotic treatment (aminopenicillin). However 5-10% of symptomatic patients have a severe multisystem defaillance. Nearly a century after the discovery of the causative agent, this zoonosis remains a public health problem, zoonosis priority in terms of virulence, its reporting is mandatory in our country. We report the case of a severe form of hepatonephritis due to water contaminated with Leptospira observed in Northern France.

Topics: Acute Kidney Injury; Adult; Amoxicillin-Potassium Clavulanate Combination; Animal Husbandry; Animals; Anti-Bacterial Agents; Bacteremia; Disease Progression; Doxycycline; Fever; France; Humans; Immunologic Tests; Jaundice; Leptospira interrogans serovar icterohaemorrhagiae; Male; Occupational Diseases; Ofloxacin; Rats; Renal Dialysis; Sheep; Species Specificity; Water Microbiology; Water Pollution; Weil Disease; Zoonoses

Topics: Acute Kidney Injury; Administration, Intravenous; Administration, Oral; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Chemotherapy-Induced Febrile Neutropenia; Chemotherapy, Adjuvant; Cyclophosphamide; Doxorubicin; Female; Fluoroquinolones; Hospitalization; Humans; Medical Overuse; Neoplasm Staging; Piperacillin, Tazobactam Drug Combination; Risk Assessment; Vancomycin

Acute kidney injury (AKI) often manifests in patients with liver disease because of a prerenal cause and presents as acute tubular necrosis or hepatorenal syndrome. Distinguishing between these entities is important for prognosis and treatment. Some patients may develop AKI related to their underlying liver disease: for example, membranoproliferative glomerulonephritis or IgA nephropathy. Bile cast nephropathy is an often ignored differential diagnosis of AKI in the setting of obstructive jaundice. It is characterized by the presence of bile casts in renal tubules, which can possibly cause tubular injury through obstructive and direct toxic effects. Thus, AKI in patients with liver disease may have a structural component in addition to a functional one.. In this study, we describe 2 patients with severe hyperbilirubinemia who developed AKI and underwent a kidney biopsy that revealed bile casts in tubular lumens, consistent with bile cast nephropathy.. One patient was treated aggressively for alcoholic hepatitis and required hemodialysis for AKI. The second patient was treated conservatively for drug-induced liver injury and did not require dialysis. Both patients saw a reduction in their bilirubin and creatinine toward baseline.. Bile cast nephropathy is an important pathological entity that may account for the renal dysfunction in some patients with liver disease. It requires kidney biopsy for diagnosis and may often be overlooked given the scarcity of kidney biopsy in this particular clinical setting. The etiology is multifactorial, and it is often difficult to predict without the aid of a renal biopsy.

Topics: Acute Kidney Injury; Adult; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; beta-Lactamase Inhibitors; Bile; Bilirubin; Biopsy; Chemical and Drug Induced Liver Injury; Creatinine; Drug Therapy, Combination; Hepatitis, Alcoholic; Humans; Hyperbilirubinemia; Jaundice, Obstructive; Kidney Tubules; Liver; Male; Microscopy, Electron; Renal Dialysis; Ultrasonography

Evidence has shown that a prophylactic antibiotic regimen of flucloxacillin and gentamicin for orthopaedic surgery was associated with increased rates of post-operative acute kidney injury (AKI). This resulted in changes in the national antibiotic policy recommendation for orthopaedic surgical prophylaxis. This study aimed to assess whether this change from flucloxacillin and gentamicin to co-amoxiclav was associated with changes in the rates of AKI and Clostridium difficile infection (CDI).. An observational study and interrupted time series analyses were used to assess rates of post-operative AKI separately in patients undergoing neck of femur (NOF) repair and other orthopaedic operations that required antibiotic prophylaxis. Incidence rate ratios were used to evaluate changes in CDI rates.. Following the change in policy, from flucloxacillin and gentamicin to co-amoxiclav, there was a relative change in rates of post-operative AKI of -63% (95% CI -77% to -49%) at 18 months in the other orthopaedic operations group. In the NOF repair group, there was no change in the rate of post-operative AKI [-10% (95% CI -35%-15%)] at 18 months. The incident rate ratio for CDI in the other orthopaedic operations group was 0.29 (95% CI 0.09-0.96) and in the NOF repair group was 0.76 (95% CI 0.28-2.08).. The use of co-amoxiclav for antibiotic prophylaxis in orthopaedic surgery was associated with a decreased rate of post-operative AKI compared with flucloxacillin and gentamicin and was not associated with increased rates of CDI.

Topics: Acute Kidney Injury; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Female; Floxacillin; Gentamicins; Health Policy; Health Services Research; Humans; Incidence; Interrupted Time Series Analysis; Male; Middle Aged; Organizational Policy; Orthopedic Procedures

Leptospirosis is a disease caused by spp. Leptospira, also known as Weil's disease if it manifests with jaundice. It can be associated with respiratory, renal, hepatic and haematological complications and most importantly carries a high mortality when untreated. We describe a case of a 53 year old man presenting with myalgia and fever in whom the diagnosis of leptospirosis was not initially considered. Following a deterioration in his condition a careful history revealed an apparent brief exposure to animal urine and subsequent grossly positive Leptospira serology. Treatment of his condition led to complete resolution after a brief stay on the intensive care unit. This case highlights the atypical nature of a presentation of Leptospirosis, its respiratory complications, and importance of serological testing in its diagnosis.

Topics: Acute Kidney Injury; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Clarithromycin; Diagnosis, Differential; Fluid Therapy; Humans; Jaundice; Leptospira; Lung; Male; Middle Aged; Oxygen Inhalation Therapy; Pneumonia, Mycoplasma; Radiography; Serologic Tests; Treatment Outcome; Weil Disease

A 43-year-old female with Staphyloccocus-induced perianal abscess, was admitted to hospital because of a clinical picture of acute renal failure and thrombotic microangiopathy. Schistocytes, thrombopenia, a negative Coombs test and no detectable plasma haptoglobin were diagnostic for thrombotic microangiopathy. Antibiotics, surgical drainage, plasmapheresis and fresh frozen plasma were given with a favourable evolution. We review the prognostic factors determining recovery of renal function and hematological abnormalities.

Topics: Abscess; Acute Kidney Injury; Adult; Amoxicillin-Potassium Clavulanate Combination; Anal Canal; Debridement; Drug Therapy, Combination; Female; Hemolytic-Uremic Syndrome; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Plasma; Plasmapheresis; Staphylococcal Infections; Thrombocytopenia

The authors report the case of a 45-year-old woman admitted for pneumonia who presented anuric acute renal failure after 12 days of intravenous amoxycillin-clavulanate treatment. Acute renal failure resolved rapidly and completely after antibiotic withdrawal. Analysis of the first post-anuric urine specimen showed many crystals. Infrared spectrophotometry revealed that the crystals were composed of trihydrated amoxycillin. The possibility of intrarenal obstruction due to massive drug crystalluria should not be overlooked in the face of abrupt anuria.

Topics: Acute Kidney Injury; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anuria; Crystallization; Drug Therapy, Combination; Female; Humans; Middle Aged; Pneumonia