Antimicrobial Stewardship May Help Address Hospital-Acquired AKI and C. difficile Infection

In treating patients with severe infections, particularly those who have been diagnosed with sepsis, physicians rely on a range of antimicrobials, although some are more commonly used than others. Over the years, research has shown that selection of antimicrobials is important for a variety of reasons beyond simply eradicating a pathogen. It has also shown that preliminary empiric treatment should be accompanied by appropriate use of diagnostics to help guide ongoing treatment. Two major complications that are  associated with the use of certain antimicrobials are Acute Kidney Injury (AKI) and C. difficile (C. diff) infections.

Acute kidney injury and C. diff infection are costly problems for hospitals and healthcare systems. These conditions are associated with poorer patient outcomes, including increased mortality and longer length of hospital stay. While these issues have been studied separately in the past, a recent paper published in Clinical Infectious Diseases is the first to explore the two together.

The researchers write that the use of certain antimicrobials is associated with increased incidence of both hospital-acquired AKI (HA-AKI) and hospital-acquired C. diff infection (HA-CDI). In particular, the data indicate that using piperacillin/tazobactam in combination with vancomycin was associated with the highest rate of hospital-acquired AKI. This is an important finding because the researchers also note that treatment for hospital-acquired infections often includes vancomycin and an antipseudomonal beta-lactam (AP-BL).

With the added complexity of growing antimicrobial resistance, infection treatment can become a difficult balancing act between eradicating the causative pathogen, protecting the kidneys and other body systems, and preventing healthcare-acquired infections such as C. diff.

“As more pathogens become resistant to available antibiotics, more people are at risk for developing sepsis, and there are less opportunities for successful treatment,” says Dr. Konrad Reinhart, intensive care physician and member of the Global Sepsis Alliance, in an article for Medical Lifesciences News. “Without curbing AMR and ensuring that clinicians can recognize the signs of sepsis and institute treatment best practices quickly, the global sepsis burden will grow.”

The good news is that the majority of deaths caused by sepsis are preventable and illnesses can be treated with prompt response and appropriate antimicrobial treatment. Prompt and appropriate treatment, along with careful monitoring and selection of antimicrobials, may then also lower a patient’s risk of developing AKI.

In the Clinical Infectious Diseases paper, the researchers write that, “When considering the risks of HA-AKI and HA-CDI, it is important to implement good antimicrobial stewardship practices. Narrowing therapy based on clinical and microbiologic findings reduces the risk of HA-CDI and shortening the duration of therapy has been associated with decreased HA-AKI and HA-CDI.” And, at the same time, practicing antimicrobial stewardship helps fight antimicrobial resistance and preserve antimicrobial efficacy for the future.