(1599) Association of Adequate Empiric Antibiotic Therapy With Acute Kidney Injury in Gram-Negative Sepsis

Introduction: Acute kidney injury (AKI) is a serious complication of sepsis and is associated with morbidity and mortality. Despite advances in sepsis management, the relationship between adequate empiric antibiotic therapy and AKI in sepsis remains unclear. We hypothesize that adequate empiric antibiotic therapy would be associated with lower risk for AKI in sepsis caused by gram-negative bloodstream infections (BSIs).

Methods: We conducted a retrospective cohort study of gram-negative BSI episodes in adult patients with early onset sepsis, using the Premier Healthcare Database from January 2016 to March 2020. Sepsis was defined using the US Center for Disease Control Adult Sepsis Event Surveillance criteria. The primary exposure was adequate empiric antibiotic therapy determined by initial choice of antibiotic regimen with adequate coverage of the gram -negative pathogen causing infection. The primary outcome was development of AKI or death by day 7 after the onset of sepsis. AKI was defined using the Kidney Disease Improving Global Outcome creatinine criteria. Secondary outcomes included C. difficile infections and in-hospital mortality. The multivariable logistic regression analysis was used to examine the association between adequate empiric antibiotic therapy and outcomes, adjusting for confounders.

Results: : We identified 8565 patients with gram-negative sepsis. In the total sample, the median age was 70 (interquartile range 60 – 79) years, 20.6% were mechanically ventilated, 46.7% received vasopressors, and hospital mortality was 9.9%. The proportion of adequate empiric antibiotic therapy was 93.2%, and the prevalence of AKI was 85.3%. Escherichia coli was the most common pathogen (55.9%). Adequate empiric antibiotic therapy was associated with decreased risk of AKI or death (odds ratio [OR] 0.70, 95% CI 0.52 - 0.94). For secondary outcomes, adequate empiric antibiotic therapy was associated with lower C. difficile infections (OR 0.54, 95% CI 0.36 - 0.81). However, it was not associated with reduction of in-hospital mortality (OR 0.99, 95% CI 0.72 - 1.36).

Conclusions: Adequate empiric antibiotic therapy was associated with lower AKI in gram-negative sepsis due to BSI. Early identification of causative pathogens and administration of adequate antibiotics may prevent development of AKI.