Abstract
BackgroundAcute kidney injury (AKI) is associated with significant increases in short- and long-term morbidity and mortality. Drug-induced AKI is a major concern in the present healthcare system. Our spontaneous reporting system (SRS) analysis assessed links between AKI, along with patients’ age, as healthcare-associated risks and administered anti-infectives. We also generated anti-infective-related AKI-onset profiles.MethodWe calculated reporting odds ratios (RORs) for reports of anti-infective-related AKI (per Medical Dictionary for Regulatory Activities) in the Japanese Adverse Drug Event Report database and evaluated the effect of anti-infective combination therapy. The background factors of cases with anti-infective monotherapy and combination therapy (≥ 2 anti-infectives) were matched using propensity score. We evaluated time-to-onset data and hazard types using the Weibull parameter.ResultsAmong 534,688 reports (submission period: April 2004–June 2018), there were 21,727 AKI events. The reported number of AKI associated with glycopeptide antibacterials, fluoroquinolones, third-generation cephalosporins, triazole derivatives, and carbapenems were 596, 494, 341, 315, and 313, respectively. Crude RORs of anti-infective-related AKI increased among older patients and were higher in anti-infective combination therapies [anti-infectives, ≥ 2; ROR, 1.94 (1.80–2.09)] than in monotherapies [ROR, 1.29 (1.22–1.36)]. After propensity score matching, the adjusted RORs of anti-infective monotherapy and combination therapy (≥ 2 anti-infectives) were 0.67 (0.58–0.77) and 1.49 (1.29–1.71), respectively. Moreover, 48.1% of AKI occurred within 5 days (median, 5.0 days) of anti-infective therapy initiation.ConclusionRORs derived from our new SRS analysis indicate potential AKI risks and number of administered anti-infectives.
Highlights
Acute kidney injury (AKI) is associated with significant increases in short- and long-term morbidity and mortality
The reported number of AKI associated with glycopeptide antibacterials, fluoroquinolones, third-generation cephalosporins, triazole derivatives, and carbapenems were 596, 494, 341, 315, and 313, respectively
Several antibiotics including penicillin analogs, cephalosporins, and ciprofloxacin are known to increase the risk of intra-renal AKI [5], and other antibiotics such as aminoglycosides, amphotericin B, and vancomycin have been identified as the cause of adverse events (AEs) in AKI [4]
Summary
Acute kidney injury (AKI) is associated with significant increases in short- and long-term morbidity and mortality. Our spontaneous reporting system (SRS) analysis assessed links between AKI, along with patients’ age, as healthcare-associated risks and administered anti-infectives. Acute kidney injury (AKI) is associated with significant increase in short- and long-term morbidity and mortality [1] and occurs in approximately 1–5% of all patients treated at the hospital [2]. Drug-induced 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 [4]. Drug-induced AKI is a major concern in the present healthcare system. Several antibiotics including penicillin analogs, cephalosporins, and ciprofloxacin are known to increase the risk of intra-renal AKI [5], and other antibiotics such as aminoglycosides, amphotericin B, and vancomycin have been identified as the cause of adverse events (AEs) in AKI [4]
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