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Critical Care |

Epidemiology of Renal Insufficiency in Patients With Ventilator-Associated Pneumonia

Lee Morrow*, MD; Pranjal Sharma, MD; Rugmini Warrier, MD; Mark Malesker, PharmD
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Creighton University, Omaha, NE


Chest. 2012;142(4_MeetingAbstracts):393A. doi:10.1378/chest.1389589
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Abstract

SESSION TYPE: Non Pulmonary Critical Care Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Renal insufficiency (RI) is common in the ICU and is associated with worse clinical outcomes. However, little is known about its epidemiology in ventilator-associated pneumonia (VAP) patients. Given the implications for dosing many ICU medications, including antibiotics, this study was undertaken to describe changes in renal function after the onset of VAP.

METHODS: We retrospectively collected data from 472 consecutive adults with clinically-diagnosed VAP diagnosed between 1/1/02 and 12/31/09 in a single academic hospital ICU. Patients with end-stage renal disease at ICU admission were excluded. Demographics, comorbid illness, daily laboratory values, antibiotic prescription, and length of stay measures were abstracted. Creatinine clearance (CrCl) was calculated daily using the Cockroft-Gault equation. 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). Subset analyses were repeated for geriatric (age ≥65 yrs) and non-geriatric patients.

RESULTS: The cohort was 64% male, had an average age of 54.3 years and an average APACHE II score of 23.6. At diagnosis of VAP 13% of patients merited consideration of renal dosage adjustment (CrCl ≤50 mL/min). This increased to 23% over the next 14 days. Compared to non-geriatric patients, significantly more geriatric patients had RI severe enough to merit consideration of renal dosage adjustment at enrollment (29% vs. 10%, p<0.001) and over the ensuing 14 days (51% vs. 16%, p<0.001).

CONCLUSIONS: RI is common in patients with VAP and is more likely to occur in geriatric patients.

CLINICAL IMPLICATIONS: This study reinforces the importance of monitoring renal function in patients with VAP in order to optimize drug dosing regimens.

DISCLOSURE: The following authors have nothing to disclose: Lee Morrow, Pranjal Sharma, Rugmini Warrier, Mark Malesker

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Creighton University, Omaha, NE

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