Antibiotics induced acute kidney injury: incidence risk factors, onset time and outcome

ABSTRACT

Drug induced acute kidney injury [AKI] has been implicated in 8% to 60% of all cases of in-hospital AKI and as such is a recognized source of significant morbidity and mortality. Evaluation of incidence, risk factors, onset time, and outcome of antibiotics' associated acute kidney injury. During one-year period, all patients who developed acute kidney injury during their hospital stay in the infectious diseases ward of Imam Khomeini hospital were included in the study prospectively. Patients' demographic data, baseline diseases, cause of current hospital admission, history of past and current medications and hemodynamic parameters were collected and monitored closely. Drug induced acute kidney injury was defined based on acute kidney injury network criteria. From 424 admitted patients, 76 [17.9%] developed acute kidney injury. Aminoglycosides [gentamicin and amikacin], amphotericin B, vancomycin, beta-lactam antibiotics [cefazolin and ceftriaxone] in monotherapy and combination therapy were the causes of acute kidney injury in most of the patients. From the co-morbid diseases in patients with acute kidney injury, diabetes mellitus [26.3%] and hypertension [5.5%], were the most frequent ones. Presence of diabetes mellitus as comorbidity [OR=2.6; CI=1.3-5.7, P=0.01], dehydration of patients upon admission [OR=3.4; CI=1.9-6.4, P<0.001], and administration of nephrotoxic combinations [OR=2.1; CI=1.2-4.1, P=0.04] were independent risk factors for antibiotic induced nephrotoxicity in our study. About 18% of the patients developed acute kidney injury during their hospitalization period in the infectious diseases ward. Aminoglycosides, amphotericin B, vancomycin and beta-lactam antibiotics were responsible agents for acute kidney injury in this study