PURPOSE: Although renal insufficiency (RI) is a frequent finding in the intensive care (ICU) and is associated with negative outcomes, little is know about its epidemiology in geriatric patients with ventilator associated pneumonia (VAP). Considering the implications for dosing many of the most commonly used ICU medications, the purpose of this project was to elucidate the changes in renal function following the onset of VAP in elderly patients.
METHODS: We prospectively evaluated data from 92 consecutive geriatric patients (age 65 years or more) with VAP diagnosed between 1/1/02 and 12/31/04. Patients with pre-existing renal failure requiring hemodialysis were not included. Data collected included demographics, co-morbid illness, daily laboratory values, antibiotics ordered, and length of stay measures. The Cockroft-Gault equation was used to calculate the creatinine clearance (CrCl) on a daily basis. Patients were classified as having no RI (CrCl > 90 ml/min), mild RI (CrCl 51–90 mL/min), moderate RI (CrCl 10–50 mL/min), or severe RI (CrCl < 10 mL/min). Renal dosing of medications was deemed necessary for patients who had moderate or severe RI.
RESULTS: The cohort was 59% male and had an average age of 71.3 years. Overall, 34% of subjects had RI severe enough to require renal dosage adjustment (CrCl < 50 mL/min) at baseline. This increased to 49% over the 14 days following VAP diagnosis. This is of clinical consequence since recent VAP treatment guidelines focus specifically on appropriate empiric antibiotic choice and appropriate antibiotic dosing.
CONCLUSION: These data demonstrate that: (1) geriatric patients with VAP have high rates of RI at baseline; and (2) these individuals are at risk for worsening renal impairment after initiating therapy.
CLINICAL IMPLICATIONS: This study underscores the need for close monitoring of renal function in geriatric VAP patients in order to appropriately optimize pharmacotherapy.
DISCLOSURE: Lee Morrow, None.