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Factors associated with acute kidney injury among preterm infants administered vancomycin: a retrospective cohort
Baek Sup Shin1, Seung Han Shin2, Seul Gi Park1
1Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
Insights
In preterm infants, combining piperacillin-tazobactam with vancomycin did not increase acute kidney injury risk. Lower gestational age and necrotizing enterocolitis were linked to kidney injury in this population.
Area of Science:
- Neonatal medicine
- Pharmacology
- Nephrology
Background:
- Vancomycin (VCM) is crucial for gram-positive infections but carries nephrotoxic risks.
- Piperacillin-tazobactam (TZP) may worsen VCM-induced nephrotoxicity in older patients.
- Limited data exists on TZP and VCM's combined effects on newborn kidney function.
Purpose of the Study:
- To determine if concurrent TZP use with VCM increases acute kidney injury (AKI) risk in preterm infants.
- To identify factors associated with AKI in VCM-treated preterm infants.
Main Methods:
- Retrospective study of preterm infants (<1,500g birth weight) receiving VCM for ≥3 days.
- AKI defined by serum creatinine increase (≥0.3 mg/dL or ≥1.5x baseline).
- Comparison of AKI incidence and associated factors between VCM+TZP and VCM-only groups.
Main Results:
- No significant difference in AKI incidence between VCM+TZP (n=25) and VCM-only (n=28) groups.
- Lower gestational age (adjusted OR: 0.58) and necrotizing enterocolitis (adjusted OR: 37.65) were significantly associated with AKI.
- Patent ductus arteriosus showed a trend towards association with AKI (adjusted OR: 5.23).
Conclusions:
- Concomitant TZP use does not elevate AKI risk in very low birth weight infants on VCM.
- Lower gestational age and necrotizing enterocolitis are key risk factors for AKI in this vulnerable population.
Background:
Vancomycin (VCM) is a widely used antibiotic for the treatment of gram-positive microorganisms, with some nephrotoxic effects. Recent studies have suggested that piperacillin-tazobactam (TZP) aggravates VCM-induced nephrotoxicity in adults and adolescents. However, there is a lack of research investigating these effects in the newborn population. Therefore, this study investigates whether the concomitant use of TZP with VCM use increases the risk of acute kidney injury (AKI) and to explore the factors associated with AKI in preterm infants treated with VCM.
Methods:
This retrospective study included preterm infants with birth weight < 1,500 g in a single tertiary center who were born between 2018 and 2021 and received VCM for a minimum of 3 days. AKI was defined as an increase in serum creatinine (SCr) of at least 0.3 mg/dL and an increase in SCr of at least 1.5 times baseline during and up to 1 week after discontinuation of VCM. The study population was categorized as those with or without concomitant use of TZP. Data on perinatal and postnatal factors associated with AKI were collected and analyzed.
Results:
Of the 70 infants, 17 died before 7 postnatal days or antecedent AKI and were excluded, while among the remaining participants, 25 received VCM with TZP (VCM + TZP) and 28 VCM without TZP (VCM-TZP). Gestational age (GA) at birth (26.4 ± 2.8 weeks vs. 26.5 ± 2.6 weeks, p = 0.859) and birthweight (750.4 ± 232.2 g vs. 838.1 ± 268.7 g, p = 0.212) were comparable between the two groups. There were no significant differences in the incidence of AKI between groups. Multivariate analysis showed that GA (adjusted OR: 0.58, 95% CI: 0.35-0.98, p = 0.042), patent ductus arteriosus (PDA) (adjusted OR: 5.23, 95% CI: 0.67-41.05, p = 0.115), and necrotizing enterocolitis (NEC) (adjusted OR: 37.65, 95% CI: 3.08-459.96, p = 0.005) were associated with AKI in the study population.
Conclusions:
In very low birthweight infants, concomitant use of TZP did not increase the risk of AKI during VCM administration. Instead, a lower GA, and NEC were associated with AKI in this population.
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