Piperacillin/tazobactam and risk of acute kidney injury in adults hospitalized with infection without vancomycin: a multi-centre real-world data analysis.

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  • Additional Information
    • Source:
      Publisher: Elsevier Science Publishers Country of Publication: Netherlands NLM ID: 9111860 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-7913 (Electronic) Linking ISSN: 09248579 NLM ISO Abbreviation: Int J Antimicrob Agents Subsets: MEDLINE
    • Publication Information:
      Original Publication: Amsterdam : Elsevier Science Publishers, c1991-
    • Subject Terms:
      Vancomycin*/adverse effects ; Acute Kidney Injury*/chemically induced ; Acute Kidney Injury*/epidemiology; Female ; Humans ; Adult ; Middle Aged ; Anti-Bacterial Agents/adverse effects ; Meropenem/adverse effects ; Ceftazidime ; Retrospective Studies ; Drug Therapy, Combination ; Piperacillin, Tazobactam Drug Combination/adverse effects ; Data Analysis ; Piperacillin/adverse effects
    • Abstract:
      Background: There is uncertainty about whether piperacillin/tazobactam (PT) increases the risk of acute kidney injury (AKI) in patients without concomitant use of vancomycin. This study compared the risk of hospital-acquired AKI (HA-AKI) among adults treated with PT or antipseudomonal β-lactams (meropenem, ceftazidime) without concomitant use of vancomycin.
      Methods: This real-world study analysed the data from China Renal Data System and assessed the risk of HA-AKI in adults hospitalized with infection after exposure to PT, meropenem or ceftazidime in the absence of concomitant vancomycin. The primary outcome was any stage of HA-AKI according to the Kidney Disease Improving Global Outcomes guidelines. A multi-variable Cox regression model and different propensity score (PS) matching models were used.
      Results: Among the 29,441 adults [mean (standard deviation) age 62.44 (16.84) years; 17,980 females (61.1%)] included in this study, 14,721 (50%) used PT, 9081 (31%) used meropenem and 5639 (19%) used ceftazidime. During a median follow-up period of 8 days, 2601 (8.8%) develped HA-AKI. The use of PT was not associated with significantly higher risk of HA-AKI compared with meropenem [adjusted hazard ratio (aHR) 1.07, 95% confidence interval (CI) 0.97-1.19], ceftazidime (aHR 1.09, 95% CI 0.92-1.30) or both agents (aHR 1.07, 95% CI 0.97-1.17) after adjusting for confounders. Results were consistent in stratified analyses, PS matching using logistic regression or random forest methods to generate a PS, and in an analysis restricting outcomes to AKI stage 2-3.
      Conclusions: Without concomitant use of vancomycin, the risk of AKI following PT therapy is comparable with that of meropenem or ceftazidime among adults hospitalized with infection.
      (Copyright © 2022 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.)
    • Contributed Indexing:
      Keywords: Acute kidney injury; Ceftazidime; Infection; Meropenem; Piperacillin/tazobactam; Real-world study
    • Accession Number:
      6Q205EH1VU (Vancomycin)
      0 (Anti-Bacterial Agents)
      FV9J3JU8B1 (Meropenem)
      9M416Z9QNR (Ceftazidime)
      157044-21-8 (Piperacillin, Tazobactam Drug Combination)
      X00B0D5O0E (Piperacillin)
    • Publication Date:
      Date Created: 20221113 Date Completed: 20230124 Latest Revision: 20230201
    • Publication Date:
      20231215
    • Accession Number:
      10.1016/j.ijantimicag.2022.106691
    • Accession Number:
      36372344