Transition From Intraoperative Vancomycin-Piperacillin Tazobactam to Vancomycin-Cefepime Does Not Change Acute Kidney Injury or Renal Recovery Outcomes in Patients Undergoing Heart Transplantation.

INTRODUCTION

The impact of empiric intraoperative vancomycin and piperacillin-tazobactam (VPT) compared to vancomycin and cefepime (VC) on AKI is equivocal, and renal recovery and infection outcomes have not been studied in this context. Further, this has not been studied in patients undergoing orthotopic heart transplantation (OHT).

METHODS

We performed a single-center prospective study in patients undergoing OHT (n = 120), with a change in intraoperative microbial coverage from VPT to VC. Primary outcomes included AKI rates and stage. Secondary outcomes included renal recovery rates, bloodstream bacterial infections, rates of enterococcal infection, ESRD (end-stage renal disease), change in eGFR, and mortality at 12 months post-OHT.

RESULTS

Rates of all stages of AKI were similar between groups (p = 0.769), and the majority of AKI in both groups were Stage 1. 27.1% of patients in the pre-intervention arm and 25.0% in the post-intervention arm had a Stage 3 AKI (p = 0.798). Rates of recovery from AKI at 7 days showed a trend toward improved recovery in patients receiving VC compared to VPT (65.1%, 46.7%, p = 0.056), but recovery from RRT at 7 days and recovery from RRT at hospital discharge were not statistically significant between groups (p = 0.140, p = 0.659). Rates of bloodstream infection were similar following the change in empiric antimicrobials (2.08%, 4.17%; p = 0.53), and rates of wound infection were similar following this change (4.2%, 1.4%; p = 0.56). There was no increase in enterococcal infections.

CONCLUSION

In patients undergoing OHT and receiving empiric antimicrobial therapy, change from VPT to VC did not affect the incidence or severity of AKI, renal recovery, or infection rates.