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. 2022 Mar 12:45:101340.
doi: 10.1016/j.eclinm.2022.101340. eCollection 2022 Mar.

Incidence, associated factors, and effect on renal function of amoxicillin crystalluria in patients receiving high doses of intravenous amoxicillin (The CRISTAMOX Study): A cohort study

Sophie Demotier  1 , Anne Limelette  2 , Alexandre Charmillon  3 , Elisabeth Baux  3 , Xavier Parent  4 , Stéphanie Mestrallet  5 , Simona Pavel  6 , Amélie Servettaz  1 , Moustapha Dramé  7 , Anaelle Muggeo  2 , Alain Wynckel  8 , Claire Gozalo  9 , Malak Abou Taam  10 , Aurélie Fillion  11 , Roland Jaussaud  12 , Thierry Trenque  13 , Lionel Piroth  14 , Firouze Bani-Sadr  1 , Maxime Hentzien  1 ; CRISTAMOX Study group
Affiliations

Incidence, associated factors, and effect on renal function of amoxicillin crystalluria in patients receiving high doses of intravenous amoxicillin (The CRISTAMOX Study): A cohort study

Sophie Demotier et al. EClinicalMedicine. .

Abstract

Background: Amoxicillin crystalluria (AC), potentially responsible for acute kidney injury (AKI), is reported more and more frequently in patients treated with high doses of intravenous amoxicillin (HDIVA). The main objective of this study was to evaluate AC incidence in these patients. The secondary objectives were to identify factors associated with AC and to evaluate its impact on the risk of AKI.

Methods: This multicentre, observational, cohort study was conducted between Mar 18, 2014 and Aug 16, 2019 in Dijon, Nancy, and Reims University Hospitals as well as Châlon-sur-Saône, Charleville-Mézières, and Troyes general hospitals in France. Adult patients (≥18 years) treated with HDIVA and having been tested for AC at least once during treatment were included. Clinical, biological, and therapeutic characteristics of the patients were collected. A univariable mixed logistic regression model assessed the factors associated with AC. A multivariable Cox model with AC as a time-dependent variable assessed the prognostic factors for AKI. ClinicalTrials.gov number: NCT02853292.

Findings: Of the 112 included patients, 27 (24.1%, 95% CI [16.2-32.0]) developed at least one episode of AC within a mean of 5.1 days. The factors associated with its occurrence were the concomitant use of angiotensin converting enzyme (ACE) inhibitors (OR=4.6, 95% CI [2.2-9.3], p<0.0001) and the decrease of urinary pH (OR=2.1 for one pH point decrease, 95% CI [1.2-3.7], p=0.009). 20 patients (17.9%) presented with AKI, within a mean time of 10.9 days. The main factor associated with the occurrence of AKI was the occurrence of AC (aHR=7.4, 95% CI [2.5-22.2], p=0.0003).

Interpretation: AC occurred in a quarter of patients treated with HDIVA and was highly prognostic of AKI.

Funding: None.

Keywords: Amoxicillin; acute kidney injury; cohort study; crystalluria; incidence.

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Conflict of interest statement

We declare no competing interests.

Figures

Figure 1:
Figure 1
Flow chart of the 112 patients who received high-dose intravenous amoxicillin treatment, included between 2014 and 2019 in participating centers in north-eastern France.
See this image and copyright information in PMC

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