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Vancomycin With Concomitant Piperacillin/Tazobactam vs. Cefepime or Meropenem Associated Acute Kidney Injury in

Ivan A Komerdelj1, Mitchell S Buckley2, Paul A D'Alessio3

  • 1Department of Pharmacy, Banner MD Anderson Cancer Center, Gilbert, AZ, USA.

Journal of Pharmacy Practice
|September 8, 2022
PubMed

Insights

Concurrent vancomycin and piperacillin/tazobactam (VAN+PTZ) significantly increases acute kidney injury (AKI) risk in hospitalized patients. This combination therapy led to earlier and more severe AKI compared to vancomycin with cefepime or meropenem.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Concurrent vancomycin and piperacillin/tazobactam (VAN+PTZ) use is common in hospitalized patients.
  • Previous reports lack comprehensive data on VAN+PTZ associated acute kidney injury (AKI) and recovery patterns.
  • Understanding the nephrotoxic potential of antibiotic combinations is crucial for patient safety.

Purpose of the Study:

  • To compare the incidence of AKI in adult general ward patients receiving VAN+PTZ versus vancomycin with cefepime (CEF) or meropenem (MER).
  • To identify VAN+PTZ as an independent risk factor for AKI.
  • To evaluate the severity and recovery patterns of AKI in different antibiotic combination groups.

Main Methods:

  • A multicenter, retrospective, propensity score cohort study design.
  • Inclusion of non-critically ill adult patients receiving either VAN+PTZ or VAN+CEF/MER.
  • Exclusion of patients with AKI within 48 hours of combination therapy initiation.
  • Primary endpoint: AKI incidence comparison; Secondary analysis: Multivariable Cox regression for AKI prediction.

Main Results:

  • A total of 3199 patients were analyzed.
  • AKI incidence was significantly higher in the VAN+PTZ group (16.4%) compared to the VAN+CEF/MER group (8.7%) (P < .001).
  • VAN+PTZ was an independent risk factor for AKI (HR 2.34, P < .001) and associated with earlier onset and more severe AKI (stage II/III).

Conclusions:

  • Concomitant VAN+PTZ is independently associated with an increased risk of AKI in adult general ward patients.
  • The VAN+PTZ combination leads to a higher incidence of overall and severe AKI.
  • No significant differences in AKI recovery patterns were observed between the studied antibiotic combinations.
Keywords:
acute kidney injurybeta-lactamnephrotoxicitypiperacillin-tazobactamvancomycin

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