Antimicrobial data set and occurrence of acute kidney injury in patients admitted to a hospital in Western Pará, Brazil

Abstract

In hospital units, the evaluation and pharmaceutical follow-up of medical prescriptions is an important source for pharmaceutical care and pharmaceutical clinical services. One common problem that has high hospital incidence rates is the occurrence of acute kidney injury (AKI). Pharmacovigilance among other activities is implemented in hospitals for the purpose of receiving and monitoring reports of adverse effects related to medications administered to patients. The survey evaluated the incidence of acute kidney injury in patients hospitalized and exposed to antimicrobials in a public hospital in the state of Pará, Brazil. A prospective and observational cohort was carried out, whose outcome of interest is the occurrence of AKI in patients admitted to the hospital between October 2018 and January 2019. The data were recorded and stored in a database, then descriptive analysis was performed in the GraphPad Prism 6.0 program. Quantitative variables were expressed as standard deviation (SD) of the mean and the number of cases as a percentage. We collected data from 70 patients who were admitted to the hospital and needed to use any of the antimicrobials selected in the observation period during hospital treatment. The survey results showed that mostly male (64.29%; n = 45). Age ranged from 19 to 96 years, with a mean of 52.49 years (SD = 20.31). The patients included were mostly from the oncology clinic (34.29%; n = 24) those that had had surgery (27.14%; n = 19). Most critically ill patients admitted to the adult ICU (26.47 %; n = 9) developed AKI. Regarding the number of medications used by patients, there was a variation from 5 to 17, with a mean of 10.26 (SD = 2.90) medications prescribed per patient. In the data regarding the antimicrobials, most patients took ceftriaxone (n = 29), cefepime (n = 27) and piperacillin/tazobactam (n = 23). In terms of the number of antimicrobials prescribed per patient, 60% (n = 42) of patients took only one, 30% (n = 21) took two and 10% (n = 7) took three or more antimicrobials for treatment of infections. The plasma concentrations of vancomycin ranged from 3.0 µg/mL to 22.5 µg/mL. Of the 10 samples collected, 10.0% (n = 1) were above the therapeutic range established by the literature (between 10 to 20 µg/mL), 30.0% (n = 3) were within the reference values and 60.0% (n = 6) of the patients had values below the reference values. Patients who developed AKI (60.0%; n = 6) during vancomycin use had concentration values between 3 µg/mL and 15.9 µg/mL, most of whom had values below the recommended therapeutic range. Of these patients with AKI, 83.33% (n = 5) used more than one nephrotoxic antimicrobial during hospital treatment. The concentrations of patients who were not diagnosed with AKI (40.0%; n = 4) ranged from 3.0 µg/mL to 22.5 µg/mL.