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Published on: August 30, 2018
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Risk of Acute Kidney Injury and Clostridioides difficile Infection With Piperacillin/Tazobactam, Cefepime, and
Jazmin D Lee1, Brett H Heintz1, Hilary J Mosher2,3
1Department of Pharmacy Services, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.
Summary
Piperacillin/tazobactam increases acute kidney injury (AKI) risk, especially with vancomycin. Cefepime and meropenem raise Clostrioides difficile infection (CDI) risk, guiding safer antibiotic selection for healthcare-associated infections.
Area of Science:
- Pharmacology
- Infectious Diseases
- Nephrology
Background:
- Healthcare-associated infections (HAIs) often treated with vancomycin and anti-pseudomonal beta-lactams (AP-BL).
- Existing research examines risks of acute kidney injury (AKI) and Clostrioides difficile infection (CDI) separately.
- Need for simultaneous evaluation of AKI and CDI risks associated with AP-BL agents.
Purpose of the Study:
- To simultaneously evaluate the risks of AKI and CDI associated with commonly used AP-BL agents.
- To compare the risks of AKI and CDI for vancomycin in combination with different AP-BLs.
- To inform clinical decision-making for empiric antimicrobial therapy in HAIs.
Main Methods:
- Retrospective cohort study of 789,200 Veterans Health Administration admissions (2010-2016).
- Examined vancomycin, cefepime, piperacillin/tazobactam, and meropenem.
- Used Cox proportional hazards regression to analyze AKI and CDI risks, adjusting for confounders.
Main Results:
- Piperacillin/tazobactam was associated with a 1.50-fold increased risk of AKI (95% CI: 1.43-1.54).
- Concurrent vancomycin use exacerbated piperacillin/tazobactam-associated AKI risk.
- Cefepime and meropenem showed increased CDI risk (HRs 1.89 and 1.99, respectively) compared to piperacillin/tazobactam.
Conclusions:
- Piperacillin/tazobactam use increases AKI risk, particularly when combined with vancomycin.
- Cefepime and meropenem are associated with higher CDI risk than piperacillin/tazobactam.
- Clinicians must weigh the risks and benefits of AP-BL agents for optimal empiric treatment selection.
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