Outbreak of acute renal failure due to cefodizime-vancomycin association in a heart surgery unit

Objective: To describe an outbreak of acute renal failure (ARF) occurring in a group of patients undergoing open-heart surgery, simultaneously to a change in perioperative antibiotic prophylaxis. Design: Case series. Setting: A nine-bed heart surgery intensive care unit, serving a 1,300-bed University teaching hospital. Patients: Thirty-two patients undergoing open-heart surgery during an 11-day period, when the preoperative surgical prophylaxis protocol had been changed from the usual antibiotic association of ceftriaxone+vancomycin to cefodizime+vancomycin. Results: ARF occurred in 16 of the 32 (50%) patients exposed to the new antibiotic prophylaxis regimen; seven patients had oliguric ARF, and nine patients had an increase in serum creatinine (SCr) levels >50% over 24–48 h. In the seven patients with oliguric ARF, SCr increased from a median preoperative level of 88 µmol/l (80–115 µmol/l) to a peak value of 725 µmol/l (521–857 µmol/l) in 5 days (4–6). Eight patients out of the sixteen with ARF (50%) were diabetics, as opposed to none of the 16 patients not experiencing ARF. Renal biopsy (three patients) showed tubular dilation and necrosis, interstitial edema, and lymphomononuclear infiltrate of moderate degree. Only one patient required hemodialysis, and all recovered renal function. No other cases of unexplained ARF occurred in the unit after the original prophylaxis protocol was resumed. Conclusion: The simultaneous infusion of cefodizime and vancomycin may involve a high risk of substantial renal function derangement, especially in diabetics.