Incidence of Acute Kidney Injury Among Patients Receiving the Combination of Vancomycin with Piperacillin-Tazobactam or Meropenem.

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  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 8111305 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1875-9114 (Electronic) Linking ISSN: 02770008 NLM ISO Abbreviation: Pharmacotherapy Subsets: MEDLINE
    • Publication Information:
      Publication: 2012- : Malden, MA : Wiley-Blackwell
      Original Publication: [Carlisle, MA : Pharmacotherapy Publications, c1981-
    • Subject Terms:
      Acute Kidney Injury/*chemically induced ; Anti-Bacterial Agents/*adverse effects ; Meropenem/*adverse effects ; Piperacillin, Tazobactam Drug Combination/*adverse effects ; Tazobactam/*adverse effects ; Vancomycin/*adverse effects; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/epidemiology ; Adult ; Aged ; Anti-Bacterial Agents/administration & dosage ; Cohort Studies ; Drug Therapy, Combination ; Female ; Humans ; Incidence ; Male ; Meropenem/administration & dosage ; Middle Aged ; Piperacillin, Tazobactam Drug Combination/administration & dosage ; Retrospective Studies ; Tazobactam/administration & dosage ; Vancomycin/administration & dosage
    • Abstract:
      Introduction: Vancomycin (VAN) is associated with an increased risk of acute kidney injury (AKI). Evidence is conflicting regarding the risk of AKI when VAN is combined with an antipseudomonal β-lactam.
      Objectives: To determine the comparative incidence of AKI when VAN is combined with piperacillin-tazobactam (PTZ) or meropenem (MER).
      Methods: This was a retrospective cohort study of acutely ill adults receiving the combination of VAN and PTZ or MER for at least 48 hours between November 1, 2014, and October 31, 2016, in a tertiary care hospital. Critically ill patients and those with baseline renal dysfunction were excluded. The primary outcome was the incidence of AKI during or within 72 hours of completing antibiotic therapy, defined as an absolute increase in serum creatinine (S cr ) of 0.5 mg/dl or higher or a 50% or more increase in S cr from baseline. Secondary outcomes included time to AKI development, duration of AKI, and length of hospitalization. Continuous variables were assessed using the Wilcoxon rank sum or the Student t test; categorical variables were assessed using χ 2 or Fisher exact tests. Independent risk factors for the development of AKI were also examined.
      Results: A total of 169 patients were evaluated. A significantly higher incidence of AKI was observed in the PTZ group compared with MER (16.5% vs 3.6%; p=0.009). The median time to AKI onset was significantly shorter with PTZ compared with MER (3 vs 7 days; p=0.009). After adjusting for baseline differences, VAN/PTZ was associated with a 6.8-fold increased risk of developing AKI (odds ratio [OR] 6.8, 95% confidence interval [CI] 1.5-30.9) compared with VAN/MER. VAN doses higher than 4 g/day and trough levels higher than 20 μg/ml were independent risk factors for developing AKI (OR 8.7, 95% CI 1.04-72.94, and OR 9.01, 95% CI 1.44-56.21, respectively).
      Conclusion: The combination of VAN/PTZ increases the risk of AKI when compared with VAN/MER in acutely ill adults.
      (© 2018 Pharmacotherapy Publications, Inc.)
    • Contributed Indexing:
      Keywords: acute kidney injury; antibacterial agents; infectious disease; meropenem; piperacillin-tazobactam; vancomycin; β-lactams
    • Accession Number:
      0 (Anti-Bacterial Agents)
      157044-21-8 (Piperacillin, Tazobactam Drug Combination)
      6Q205EH1VU (Vancomycin)
      FV9J3JU8B1 (Meropenem)
      SE10G96M8W (Tazobactam)
    • Publication Date:
      Date Created: 20180904 Date Completed: 20190910 Latest Revision: 20190910
    • Publication Date:
      20221213
    • Accession Number:
      10.1002/phar.2179
    • Accession Number:
      30175410