Related Experiment Video

Updated: Sep 18, 2025

Robot-Assisted Kidney Transplantation
07:30

Robot-Assisted Kidney Transplantation

Published on: July 19, 2021

3.7K

Transition From Intraoperative Vancomycin-Piperacillin Tazobactam to Vancomycin-Cefepime Does Not Change Acute Kidney

Ashley L Golbus1, Syed Quadri2, Elaine Park1

  • 1College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.

Clinical Transplantation
|June 24, 2025
PubMed
Abstract

Insights

Changing intraoperative antibiotics from vancomycin and piperacillin-tazobactam (VPT) to vancomycin and cefepime (VC) did not impact acute kidney injury (AKI) or infection rates in heart transplant patients. Renal recovery and other outcomes remained similar between the two antibiotic regimens.

Area of Science:

  • Nephrology
  • Cardiology
  • Infectious Diseases

Background:

  • The impact of empiric intraoperative antibiotics vancomycin and piperacillin-tazobactam (VPT) versus vancomycin and cefepime (VC) on acute kidney injury (AKI) is unclear.
  • Renal recovery and infection outcomes in this context, particularly after orthotopic heart transplantation (OHT), require further investigation.

Purpose of the Study:

  • To evaluate the effect of switching intraoperative antimicrobial coverage from VPT to VC on AKI rates and severity in OHT patients.
  • To assess secondary outcomes including renal recovery, bloodstream infections, enterococcal infections, end-stage renal disease (ESRD), eGFR changes, and mortality.

Main Methods:

  • A single-center prospective study involving 120 patients undergoing OHT.
  • Patients received either VPT or VC for intraoperative microbial coverage, with a switch from VPT to VC during the study period.
  • Primary outcomes were AKI rates and stage; secondary outcomes included renal recovery, infection rates, and mortality.

Main Results:

  • No significant difference in AKI rates or severity was observed between the VPT and VC groups (p = 0.769).
  • The majority of AKI cases were Stage 1, with similar rates of Stage 3 AKI between groups (27.1% vs. 25.0%, p = 0.798).
  • Rates of bloodstream infections (2.08% vs. 4.17%, p = 0.53) and wound infections (4.2% vs. 1.4%, p = 0.56) were similar, with no increase in enterococcal infections.

Conclusions:

  • Switching empiric intraoperative antimicrobial therapy from VPT to VC in OHT patients did not alter the incidence or severity of AKI.
  • The change in antibiotic regimen did not significantly affect renal recovery rates or infection outcomes.
  • VC can be considered a safe alternative to VPT in OHT patients regarding renal and infectious complications.
Keywords:
acute kidney injuryantimicrobialnephrotoxicityorthotopic heart transplantationrenal recovery

More Related Videos

A Modified Surgical Technique for Kidney Transplantation in Mice10:38

A Modified Surgical Technique for Kidney Transplantation in Mice

Published on: July 22, 2022

6.2K
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion09:02

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion

Published on: February 2, 2021

4.6K

Related Concept Videos

Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
78
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
64
Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
65
Acute Kidney Injury I: Introduction01:22

Acute Kidney Injury I: Introduction

Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
83
Kidney Transplant III: Nursing Management01:16

Kidney Transplant III: Nursing Management

Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
85
Acute Kidney Injury II: Pathophysiology01:29

Acute Kidney Injury II: Pathophysiology

Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
101