148 Chapter 7 Legend: Values are count (%) for categorical variables and median (IQR) for continuous variables Chronic kidney disease was defined as an eGFR < 60 ml/min/1,73 m2. Clinical and laboratory parameters are at presentation. Treatment implies the antibiotics prescribed after the first positive blood culture. ACE-i angiotensin-converting-enzyme inhibitors, ARB angiotensin II receptor blockers. Uncomplicated SAB was defined as an episode of bacteremia with ≥ 1 blood culture with S. aureus, without evidence of endocarditis/ metastatic infection, and without positive cultures after 48 h of adequate therapy and that was treated for a maximum of 2 weeks, and no relapse occurred, and the patient survived > 72 h after presentation. All situations that did not meet the criteria for uncomplicated SAB were considered complicated SAB. Incidence and severity of AKI Acute kidney injury developed in 115/315 (37%; 95%CI 31–42%) of all patients. In the majority of patients, the maximum creatinine was between 1.5 and 2.5 times baseline (Table 2). In patients with complicated SAB, AKI was found more frequently (83/181; 46%) compared to patients with uncomplicated SAB (32/134; 24%; p = < 0.01; OR = 2.70; 95%CI 1.65–4.42). Figure 1a depicts the time from first positive blood culture to maximum creatinine in days, in the 115 patients with AKI. In 45/115 (39%) patients, the maximum creatinine was reached on the day of first blood culture sampling. The median time from first positive blood culture to AKI was 3 days (IQR = 0–11 days). Development of AKI during SAB was associated with 30-day mortality (OR 3.9; 95%CI 2.2–6.9; p < 0.01). In the patients with non-reversible AKI, 27/47 (57%) died within 30 days after blood culture sampling. Reversibility Recovery of renal function to < 1.5 times baseline creatinine occurred in 68/115 (59%; 95%CI 49–68%) of patients. There was a small numerical difference in reversibility between complicated and uncomplicated SAB (respectively 60% versus 56%, p = 0.83). The proportion of recovery of AKI was higher in the category of patients with a maximum creatinine of < 2.5 times baseline creatine compared to the more severe kidney injuries (respectively 68% vs 44%, p = 0.02). In patients with reversible AKI, the median time to recovery was two days (IQR = 1–4 days). In 56/68 (82%; 95%CI 73–92%), the recovery occurred within 7 days (Fig. 1b). Among the patients with persistent renal impairment after 7 days, only 12/59 (20%; 95%CI 11–32%) recovered eventually, after temporary renal replacement therapy in five of them. There was no statistically significant difference in reversibility of AKI between patients who presented with AKI and patient who developed AKI during admission (respectively 64% vs 56%, p = 0.45). In the selection of patients still alive at day 30, the recovery rate within 30 days after SAB onset was 52/71 (72%).
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