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Published on: August 30, 2018
Factors Affecting Vancomycin and Piperacillin-Tazobactam-Induced Nephrotoxicity
Mollie VanNatta Day1, Ruhul Munshi2, Kalyn Picard2
1Ochsner LSU Health Shreveport, Academic Medical Center, 1541 Kings Highway, Shreveport, LA 71103, USA.
Journal of Clinical Medicine
|July 15, 2026
Summary
The combination of vancomycin and piperacillin-tazobactam can cause acute kidney injury (AKI) in 25.4% of patients. Higher body mass index (BMI) and intravenous (IV) contrast use increase nephrotoxicity risk.
Area of Science:
- Nephrology
- Pharmacology
- Critical Care Medicine
Background:
- Vancomycin and piperacillin-tazobactam combination nephrotoxicity is debated.
- The specific impact on acute kidney injury (AKI) is uncertain.
- Identifying risk factors for nephrotoxicity is crucial.
Purpose of the Study:
- To investigate the incidence of AKI in patients receiving vancomycin and piperacillin-tazobactam.
- To identify determinants of AKI in this patient population.
Main Methods:
- Retrospective cohort study (May 2019-March 2023).
- Included adult patients receiving dual therapy for ≥48 hours.
- Compared demographic features, concomitant nephrotoxic agents, infection site, vasopressor use, therapy duration, and vancomycin levels between AKI and non-AKI groups.
Main Results:
- AKI occurred in 25.4% of 350 patients.
- Elevated vancomycin trough/AUC/MIC, higher BMI, and IV contrast use were associated with AKI.
- African American patients showed a higher incidence of AKI (51.7%).
Conclusions:
- Vancomycin and piperacillin-tazobactam combination therapy is associated with a 25.4% AKI incidence.
- Higher BMI and IV contrast use are significant risk factors for nephrotoxicity.
- Caution is advised when using this combination in patients with elevated BMI or prior IV contrast exposure.
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