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Association between piperacillin/tazobactam use and acute kidney injury in critically ill patients: a retrospective
Bruno Martins Tomazini1,2,3, Bruno Adler Maccagnan Pinheiro Besen2,3,4, Leandro Utino Taniguchi2,3,4
1Research Institute, Hospital do Coração (Hcor), Sao Paulo, Brazil.
Background:
Piperacillin/tazobactam is one of the most common antibiotics prescribed in the ICU and the combination of piperacillin/tazobactam with vancomycin has been associated with acute kidney injury (AKI) in critically ill patients. However, data on the risk of AKI with piperacillin/tazobactam, despite vancomycin co-exposure, are lacking.
Objectives:
To investigate the association of piperacillin/tazobactam with AKI and renal replacement therapy (RRT) among adult ICU patients.
Methods:
We analysed data from patients included in two open access databases (MIMIC-IV and eICU). Critically ill patients who received piperacillin/tazobactam or cefepime (a cephalosporin with similar broad-spectrum activity to piperacillin/tazobactam) during their first ICU stay were eligible for the study. Marginal structural Cox models, accounting for time-fixed covariates and time-dependent covariates were performed. The primary outcomes were AKI and need of RRT.
Results:
A total of 20 107 patients were included, with 11 213 in the piperacillin/tazobactam group and 8894 in the cefepime group. Exposure to piperacillin/tazobactam was associated with AKI (HR 1.77; 95% CI 1.51-2.07; P < 0.001) and with need of RRT (HR 1.31; 95% CI 1.08-1.57; P = 0.005). Tests for interaction were not statistically significant for occurrence of AKI and RRT in the subgroup of patients exposed to vancomycin or not (P = 0.26 and P = 0.6, respectively).
Conclusions:
In critically ill patients, exposure to piperacillin/tazobactam was associated with increased risk of AKI and with increased risk of RRT, regardless of combination therapy with vancomycin.
Insights
Piperacillin/tazobactam use in ICUs is linked to a higher risk of acute kidney injury (AKI) and the need for renal replacement therapy (RRT). This increased risk persists even when combined with vancomycin.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Nephrology
Background:
- Piperacillin/tazobactam is a common ICU antibiotic.
- Vancomycin combination is linked to acute kidney injury (AKI).
- Data on piperacillin/tazobactam's AKI risk without vancomycin is limited.
Purpose of the Study:
- To investigate the association between piperacillin/tazobactam and AKI.
- To assess the risk of renal replacement therapy (RRT) with piperacillin/tazobactam.
- To examine these risks in adult ICU patients.
Main Methods:
- Analysis of data from MIMIC-IV and eICU databases.
- Inclusion of critically ill patients receiving piperacillin/tazobactam or cefepime.
- Use of marginal structural Cox models to analyze outcomes.
Main Results:
- 20,107 patients were analyzed; 11,213 received piperacillin/tazobactam.
- Piperacillin/tazobactam exposure was associated with increased AKI risk (HR 1.77) and RRT need (HR 1.31).
- No significant interaction for AKI or RRT risk with vancomycin co-exposure.
Conclusions:
- Piperacillin/tazobactam is associated with a higher risk of AKI in critically ill patients.
- Piperacillin/tazobactam use increases the likelihood of requiring RRT.
- These risks are present irrespective of concurrent vancomycin treatment.
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