A Large-Scale Multicenter Retrospective Study on Nephrotoxicity Associated With Empiric Broad-Spectrum Antibiotics in...

Area of Science:

• Nephrology
• Critical Care Medicine
• Pharmacology

Background:

• Conflicting evidence exists on acute kidney injury (AKI) risk with vancomycin and piperacillin-tazobactam (VPT) co-administration, especially in intensive care unit (ICU) patients.
• Common empiric antibiotic regimens in ICUs include vancomycin combined with piperacillin-tazobactam, cefepime, or meropenem.

Purpose of the Study:

• To investigate the association between commonly prescribed empiric antibiotic combinations and AKI in ICU patients.
• To compare the risk of AKI associated with vancomycin and piperacillin-tazobactam versus vancomycin and cefepime, and vancomycin and meropenem.

Main Methods:

• Retrospective cohort study utilizing the eICU Research Institute database (2010-2015).
• Included patients receiving exclusive vancomycin and piperacillin-tazobactam, vancomycin and cefepime, or vancomycin and meropenem.
• Defined AKI as Kidney Disease: Improving Global Outcomes stage 2 or 3; employed propensity score matching and calculated odds ratios (ORs).

Main Results:

• Vancomycin and piperacillin-tazobactam (VPT) was associated with a significantly higher risk of AKI (OR, 1.37) and dialysis initiation (OR, 1.28) compared to vancomycin and cefepime.
• VPT also showed a higher risk of AKI (OR, 1.27) and dialysis initiation (OR, 1.56) compared to vancomycin and meropenem.
• The increased risk of AKI with VPT was more pronounced in patients without prior renal insufficiency receiving longer treatment durations.

Conclusions:

• Vancomycin and piperacillin-tazobactam (VPT) is linked to a greater risk of acute kidney injury in ICU patients compared to vancomycin with cefepime or meropenem.
• This association is particularly significant for patients with normal baseline kidney function requiring extended VPT therapy.
• Clinicians should consider vancomycin and meropenem or vancomycin and cefepime to mitigate nephrotoxicity risk in ICU settings.