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Vancomycin with concomitant piperacillin/tazobactam vs. cefepime or meropenem associated acute kidney injury in the

Mitchell S Buckley1, Ivan A Komerdelj2, Paul A D'Alessio3

  • 1Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.

Journal of Critical Care
|November 12, 2021
PubMed
Abstract

Insights

Concomitant vancomycin and piperacillin/tazobactam increased acute kidney injury (AKI) risk in ICU patients. This combination therapy showed a higher incidence of AKI compared to vancomycin with cefepime or meropenem.

Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Nephrology

Background:

  • The use of vancomycin in combination with piperacillin/tazobactam is common in intensive care units (ICUs).
  • The potential for acute kidney injury (AKI) associated with this combination remains a subject of debate.
  • Alternative beta-lactam agents like cefepime or meropenem are often used with vancomycin.

Purpose of the Study:

  • To compare the incidence of AKI in adult ICU patients receiving vancomycin with piperacillin/tazobactam versus vancomycin with cefepime or meropenem.
  • To identify if the combination of vancomycin and piperacillin/tazobactam is an independent risk factor for AKI.

Main Methods:

  • A multicenter, retrospective, propensity score-matched cohort study.
  • Inclusion of adult ICU patients receiving vancomycin with piperacillin/tazobactam, cefepime, or meropenem.
  • Exclusion of patients with AKI within 48 hours of therapy initiation; primary endpoint was AKI incidence; multivariable Cox regression was used.

Main Results:

  • A total of 1044 patients were matched.
  • The incidence of AKI was 21.9% in the vancomycin-piperacillin/tazobactam group and 16.8% in the vancomycin-cefepime/meropenem group (p=0.068).
  • Vancomycin-piperacillin/tazobactam was an independent risk factor for AKI (HR 1.52, p=0.011 using creatinine; HR 1.77, p=0.006 using creatinine and urine output).

Conclusions:

  • Concomitant vancomycin and piperacillin/tazobactam administration is independently associated with an increased risk of AKI in adult ICU patients.
  • The findings suggest a need for careful monitoring of renal function when this antibiotic combination is used.
  • No significant differences in AKI recovery or mortality were observed between the groups.
Keywords:
Acute kidney injuryNephrotoxicityPiperacillin/tazobactamVancomycin, critical care, intensive care unitbeta-lactam

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