meropenem and Renal-Insufficiency--Chronic

Topics: Drug Interactions; HEK293 Cells; Humans; Kidney; Meropenem; Organic Anion Transporters, Sodium-Independent; Renal Insufficiency, Chronic

To study the incidence of vancomycin-associated acute kidney injury (VA-AKI) in Hong Kong and identify risk factors for VA-AKI.. Patients with vancomycin prescription and blood level measurement in 2012-2016 were identified using the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System. Acute kidney injury was defined using KDIGO criteria. Patients without creatinine measurements, steady-state trough vancomycin level or who had vancomycin treatment < 3 days were excluded. Results were analyzed using SPSS version 22.0. Logistic regression was used to identify the predictors for VA-AKI. Odds ratio and 95% confidence interval were estimated.. One thousand four hundred fifty patients were identified as VA-AKI from 12,758 records in Hong Kong in 2012-2016. The incidence was respectively 10.6, 10.9, 11.3, 12.2, 11.2% from 2012 to 2016. The incidence of VA-AKI was 16.3, 12.2, 11.3 and 6.2% in patients aged 1-12, 12-60, elderly aged > 60 and newborn and infants, respectively. Baseline creatinine, serum trough vancomycin level, systematic disease history including respiratory failure, hypertension, congestive heart failure, chronic renal failure, anemia and type II diabetes, and concomitant diuretics, piperacillin-tazobactam (PTZ) and meropenem prescription were significantly higher in VA-AKI patients older than 12 years. Logistic regression showed that older age group, higher baseline creatinine, serum trough vancomycin level, respiratory failure, chronic renal failure and congestive heart failure, concomitant diuretics, PTZ and meropenem prescription, and longer hospital stay were all associated with increased risk of VA-AKI.. The incidence of VA-AKI in Hong Kong is low but shows no decline. Patients with higher baseline creatinine, multi-organ diseases and multiple drugs administration should have their vancomycin level monitored to decrease the risk of VA-AKI.

Topics: Acute Kidney Injury; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Child, Preschool; Comorbidity; Creatinine; Diuretics; Female; Heart Failure; Hong Kong; Humans; Incidence; Infant; Infant, Newborn; Length of Stay; Male; Meropenem; Middle Aged; Piperacillin, Tazobactam Drug Combination; Renal Insufficiency, Chronic; Respiratory Insufficiency; Risk Factors; Vancomycin; Young Adult

The management of patients with brain abscess poses a significant challenge to clinicians in patients with chronic kidney disease. Obtaining a biopsy sample from the affected area is the mainstay in the diagnosis, but it is often unavailable. In most cases, therapy is guided by clinical findings and imaging alone. We discuss three cases of brain abscess- each with a different scenario and discuss the issues faced in management. The first case was a 32-year-old post-renal transplant male patient with a brain abscess due to dematiaceous fungi and was treated with amphotericin. The second case was a 42-year-old female patient with stage 5 chronic kidney disease on maintenance hemodialysis who presented with a brain abscess due to suspected fungal infection based on imaging findings and was managed with antibiotics and voriconazole. The third case was a 42-year-old post-renal transplant male patient who presented with a brain abscess due to nocardiosis and was managed with cotrimoxazole, meropenem and linezolid. We also summarize the approach to the management of brain abscess in resource-limited settings.

Topics: Adult; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Brain Abscess; Female; Humans; Kidney Transplantation; Linezolid; Male; Meropenem; Mycoses; Renal Insufficiency, Chronic; Trimethoprim, Sulfamethoxazole Drug Combination; Voriconazole

Topics: Abdomen; Adult; Anti-Bacterial Agents; Clindamycin; Coinfection; Debridement; Diabetes Mellitus, Type 2; Fasciitis, Necrotizing; Female; Fluid Therapy; Humans; Meropenem; Methicillin-Resistant Staphylococcus aureus; Obesity; Renal Insufficiency, Chronic; Resuscitation; Staphylococcal Infections; Streptococcal Infections; Streptococcus pyogenes; Vancomycin