Vancomycin prophylaxis and acute kidney injury after cardiac surgery

Vancomycin prophylaxis and acute kidney injury after cardiac surgery Cardiac surgery, Acute kidney injury, Antibiotic prophylaxis, Vancomycin I read with great interest the article by Reineke et al. [1] about adding vancomycin to perioperative prophylaxis in high-risk cardiac surgery patients to possibly decrease deep sternal wound infections. The study included 1493 patients who were deemed to be at high risk for deep sternal wound infections, and of these, 639 patients received vancomycin in addition to routine cefuroxime prophylaxis. The study reported a significant reduction in deep sternal wound infections in high-risk cardiac surgery patients in whom vancomycin was added to standard cephalosporin antibiotic prophylaxis. Although patients seemed to benefit from a reduced risk of serious wound infections in this study, this needs to be carefully weighed against the well-known risk of vancomycin-associated nephrotoxicity [2]. Acute kidney injury after cardiac surgery is associated with increased morbidity and mortality [3–5]. Teicoplanin may be less nephrotoxic than vancomycin, but has been shown to increase the risk of acute kidney injury, particularly in women and patients with impaired renal function, when used as prophylaxis in cardiac surgery [6]. In the article by Reineke et al. [1], there was no difference in peak postoperative creatinine or the need for postoperative dialysis between patients who received vancomycin in addition to cefuroxime and those who received only cefuroxime. However, the peak postoperative creatinine and the need for postoperative dialysis are not sensitive measures of renal injury. Prior studies have shown that even minor increases in the postoperative serum creatinine level following coronary artery bypass surgery is associated with long-term all-cause mortality and cardiovascular outcomes independent of preoperative renal function [3]. Therefore, it would be valuable if the authors were able to investigate the incidence of acute kidney injury preferably using the Acute Kidney Injury Network (AKIN) or the Kidney Disease: Improving Global Outcomes (KDIGO) definitions. It is possible that the reduction in the rate of serious wound infections observed in this study led to an increased incidence of acute kidney injury. Fortunately, this question could be addressed if the authors would perform additional analyses. Before a general recommendation to use vancomycin as additional prophylaxis in high-risk patients undergoing cardiac surgery can be made, the complete safety profile of such a strategy must be explored. The article by Reineke et al. [1] could hopefully provide better evidence in this area, and additional analyses of the collected data have the potential to further inform clinical practice and improve patient care. Conflict of interest: none declared. REFERENCES [1] Reineke S , Carrel TP , Eigenmann V , Gahl B , Fuehrer U , Seidl C et al. Adding vancomycin to perioperative prophylaxis decreases deep sternal wound infections in high-risk cardiac surgery patients . Eur J Cardiothorac Surg 2018 ; 53 : 428 – 34 . Google Scholar CrossRef Search ADS [2] Filippone EJ , Kraft WK , Farber JL. The nephrotoxicity of vancomycin . Clin Pharmacol Ther 2017 ; 102 : 459 – 69 . Google Scholar CrossRef Search ADS PubMed [3] Liotta M , Olsson D , Sartipy U , Holzmann MJ. Minimal changes in postoperative creatinine values and early and late mortality and cardiovascular events after coronary artery bypass grafting . Am J Cardiol 2014 ; 113 : 70 – 5 . Google Scholar CrossRef Search ADS PubMed [4] Olsson D , Sartipy U , Braunschweig F , Holzmann MJ. Acute kidney injury following coronary artery bypass surgery and long-term risk of heart failure . Circ Heart Fail 2013 ; 6 : 83 – 90 . Google Scholar CrossRef Search ADS PubMed [5] Ryden L , Sartipy U , Evans M , Holzmann MJ. Acute kidney injury after coronary artery bypass grafting and long-term risk of end-stage renal disease . Circulation 2014 ; 130 : 2005 – 11 . Google Scholar CrossRef Search ADS PubMed [6] Olsson DP , Holzmann MJ , Sartipy U. Antibiotic prophylaxis by teicoplanin and risk of acute kidney injury in cardiac surgery . J Cardiothorac Vasc Anesth 2015 ; 29 : 626 – 31 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Vancomycin prophylaxis and acute kidney injury after cardiac surgery

Loading next page...
 
/lp/ou_press/vancomycin-prophylaxis-and-acute-kidney-injury-after-cardiac-surgery-Rala8aj9JT
Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
ISSN
1010-7940
eISSN
1873-734X
D.O.I.
10.1093/ejcts/ezx490
Publisher site
See Article on Publisher Site

Abstract

Cardiac surgery, Acute kidney injury, Antibiotic prophylaxis, Vancomycin I read with great interest the article by Reineke et al. [1] about adding vancomycin to perioperative prophylaxis in high-risk cardiac surgery patients to possibly decrease deep sternal wound infections. The study included 1493 patients who were deemed to be at high risk for deep sternal wound infections, and of these, 639 patients received vancomycin in addition to routine cefuroxime prophylaxis. The study reported a significant reduction in deep sternal wound infections in high-risk cardiac surgery patients in whom vancomycin was added to standard cephalosporin antibiotic prophylaxis. Although patients seemed to benefit from a reduced risk of serious wound infections in this study, this needs to be carefully weighed against the well-known risk of vancomycin-associated nephrotoxicity [2]. Acute kidney injury after cardiac surgery is associated with increased morbidity and mortality [3–5]. Teicoplanin may be less nephrotoxic than vancomycin, but has been shown to increase the risk of acute kidney injury, particularly in women and patients with impaired renal function, when used as prophylaxis in cardiac surgery [6]. In the article by Reineke et al. [1], there was no difference in peak postoperative creatinine or the need for postoperative dialysis between patients who received vancomycin in addition to cefuroxime and those who received only cefuroxime. However, the peak postoperative creatinine and the need for postoperative dialysis are not sensitive measures of renal injury. Prior studies have shown that even minor increases in the postoperative serum creatinine level following coronary artery bypass surgery is associated with long-term all-cause mortality and cardiovascular outcomes independent of preoperative renal function [3]. Therefore, it would be valuable if the authors were able to investigate the incidence of acute kidney injury preferably using the Acute Kidney Injury Network (AKIN) or the Kidney Disease: Improving Global Outcomes (KDIGO) definitions. It is possible that the reduction in the rate of serious wound infections observed in this study led to an increased incidence of acute kidney injury. Fortunately, this question could be addressed if the authors would perform additional analyses. Before a general recommendation to use vancomycin as additional prophylaxis in high-risk patients undergoing cardiac surgery can be made, the complete safety profile of such a strategy must be explored. The article by Reineke et al. [1] could hopefully provide better evidence in this area, and additional analyses of the collected data have the potential to further inform clinical practice and improve patient care. Conflict of interest: none declared. REFERENCES [1] Reineke S , Carrel TP , Eigenmann V , Gahl B , Fuehrer U , Seidl C et al. Adding vancomycin to perioperative prophylaxis decreases deep sternal wound infections in high-risk cardiac surgery patients . Eur J Cardiothorac Surg 2018 ; 53 : 428 – 34 . Google Scholar CrossRef Search ADS [2] Filippone EJ , Kraft WK , Farber JL. The nephrotoxicity of vancomycin . Clin Pharmacol Ther 2017 ; 102 : 459 – 69 . Google Scholar CrossRef Search ADS PubMed [3] Liotta M , Olsson D , Sartipy U , Holzmann MJ. Minimal changes in postoperative creatinine values and early and late mortality and cardiovascular events after coronary artery bypass grafting . Am J Cardiol 2014 ; 113 : 70 – 5 . Google Scholar CrossRef Search ADS PubMed [4] Olsson D , Sartipy U , Braunschweig F , Holzmann MJ. Acute kidney injury following coronary artery bypass surgery and long-term risk of heart failure . Circ Heart Fail 2013 ; 6 : 83 – 90 . Google Scholar CrossRef Search ADS PubMed [5] Ryden L , Sartipy U , Evans M , Holzmann MJ. Acute kidney injury after coronary artery bypass grafting and long-term risk of end-stage renal disease . Circulation 2014 ; 130 : 2005 – 11 . Google Scholar CrossRef Search ADS PubMed [6] Olsson DP , Holzmann MJ , Sartipy U. Antibiotic prophylaxis by teicoplanin and risk of acute kidney injury in cardiac surgery . J Cardiothorac Vasc Anesth 2015 ; 29 : 626 – 31 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

European Journal of Cardio-Thoracic SurgeryOxford University Press

Published: Jan 2, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off