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Published on: August 30, 2018
Comparison of Acute Kidney Injury During Treatment with Vancomycin and either Piperacillin-Tazobactam or Meropenem
John M Cannon1, Richard W Douce2, Erin R Grubbs1
1Lakeland Health Department of Pharmacy, Clinical Pharmacist, St. Joseph, MI.
Context:
Empiric antibiotics are often required in hospitalized patients with serious infections who may be septic and at risk for drug resistant organisms. The purpose of this study was to evaluate the observed incidence of acute kidney injury (AKI) in a sample of adult patients receiving either piperacillin-tazobactam and vancomycin or meropenemvancomycin for at least 72 hours.
Methods:
Single-center, retrospective matched cohort at a 200-bed Regional Community Medical Center. Adult patients were included in the sample if they were without preexisting renal dysfunction and admitted over an 18-month time period to receive either the combination of piperacillin-tazobactam and vancomycin or meropenem-vancomycin. Sample patients were evaluated for AKI. This condition was defined by the authors as an increase in serum creatinine of 0.5mg/ml or an increase of 50% above baseline during the duration of antibiotic treatment.
Results:
A total of 266 patients receiving either combination of antibiotics were evaluated for AKI. The incidence of AKI was significantly higher in the piperacillin-tazobactam and vancomycin group (n = 74/292, 25%) compared with the meropenem-vancomycin group (n=8/74, 9.5%, p=0.008).
Conclusions:
The results of this study suggest that the combination of piperacillin-tazobactam and vancomycin is associated with an increased incidence of AKI. Higher vancomycin trough concentrations were associated with increased risk for development of AKI.
Insights
The combination of piperacillin-tazobactam and vancomycin was linked to a higher incidence of acute kidney injury (AKI) compared to meropenem-vancomycin. Higher vancomycin levels increased AKI risk in hospitalized patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Hospitalized patients with serious infections often require empiric antibiotics.
- Risk of drug-resistant organisms and sepsis necessitates careful antibiotic selection.
- Acute kidney injury (AKI) is a potential complication of broad-spectrum antibiotic use.
Purpose of the Study:
- To evaluate the observed incidence of AKI in adult patients receiving specific antibiotic combinations.
- To compare AKI rates between piperacillin-tazobactam/vancomycin and meropenem/vancomycin regimens.
Main Methods:
- Retrospective matched cohort study at a community medical center.
- Adult patients without pre-existing renal dysfunction receiving antibiotics for ≥72 hours were included.
- AKI defined as a 0.5 mg/dL creatinine increase or 50% rise from baseline.
Main Results:
- 266 patients were evaluated for AKI.
- AKI incidence was significantly higher in the piperacillin-tazobactam/vancomycin group (25%) versus the meropenem/vancomycin group (9.5%).
- p=0.008 indicated a statistically significant difference in AKI rates.
Conclusions:
- Piperacillin-tazobactam and vancomycin combination therapy is associated with increased AKI incidence.
- Elevated vancomycin trough concentrations correlated with a higher risk of developing AKI.
- Meropenem-vancomycin may be a safer alternative regarding nephrotoxicity.
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