Incidence of Acute Kidney Injury Among Patients Receiving the Combination of Vancomycin with Piperacillin-Tazobactam

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Amy D Robertson1,2, Chenghui Li3, Drayton A Hammond4

  • 1Department of Pharmacy Practice, University of Arkansas for Medical Sciences Northwest Regional Campus, Fayetteville, Arkansas.

Pharmacotherapy
|September 4, 2018
PubMed
Abstract

Insights

Vancomycin combined with piperacillin-tazobactam (PTZ) significantly increases acute kidney injury (AKI) risk compared to vancomycin with meropenem (MER). This finding is crucial for managing infections and preventing kidney damage in acutely ill patients.

Area of Science:

  • Nephrology and Infectious Diseases
  • Clinical Pharmacology and Therapeutics

Background:

  • Vancomycin (VAN) use is linked to acute kidney injury (AKI).
  • Conflicting evidence exists regarding the AKI risk when VAN is combined with antipseudomonal β-lactams.

Purpose of the Study:

  • To compare the incidence of AKI in acutely ill adults receiving VAN combined with piperacillin-tazobactam (PTZ) versus meropenem (MER).

Main Methods:

  • Retrospective cohort study of 169 adult patients receiving VAN/PTZ or VAN/MER for ≥48 hours.
  • Exclusion of critically ill patients and those with baseline renal dysfunction.
  • Primary outcome: AKI incidence defined by serum creatinine increase; secondary outcomes: time to AKI, duration, and hospitalization length.

Main Results:

  • AKI incidence was significantly higher with VAN/PTZ (16.5%) compared to VAN/MER (3.6%).
  • Time to AKI onset was shorter with VAN/PTZ (3 days) versus VAN/MER (7 days).
  • VAN/PTZ was associated with a 6.8-fold increased risk of AKI after adjustment.

Conclusions:

  • The combination of VAN/PTZ increases the risk of AKI compared to VAN/MER in acutely ill adults.
  • High VAN doses (>4 g/day) and trough levels (>20 μg/ml) were independent risk factors for AKI.
Keywords:
acute kidney injuryantibacterial agentsinfectious diseasemeropenempiperacillin-tazobactamvancomycinβ-lactams

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