Acute Renal Failure Associated with Vancomycin and Beta-lactams for the Treatment of Osteomyelitis in Diabetics: Piperacillin/Tazobactam Compared to Cefepime.
Clin Microbiol Infect. 2013 Oct 1;
Authors: Moenster RP, Linneman TW, Finnegan PM, Hand S, Thomas Z, McDonald JR
Abstract
BACKGROUND: Little data is available comparing the nephrotoxic potential of vancomycin when combined with certain beta-lactam antibiotics for the treatment of osteomyelitis (OM).
METHODS: A retrospective cohort study was conducted of all diabetic patients with OM treated with vancomycin plus either piperacillin/tazobactam (VPT) or cefepime (VC) for at least 72 hours at a VA Medical Center between 1 January 2006 and 31 December 2011. All patients with a creatinine clearance (CrCl) ≤ 40 mL/min, blood-urea nitrogen to serum creatinine (BUN:SCr) ratio ≥20:1, or absolute neutrophil count <500 cells/mm(3) were excluded. The primary outcome was development of acute renal failure (ARF), defined as an increase in SCr of 0.5 mg/dL or 50% of baseline.
RESULTS: One hundred thirty-nine patients met inclusion criteria; 109 in the piperacillin/tazobactam group and 30 in the cefepime group. In patients receiving VPT, 29.3% (32/109) developed ARF compared to 13.3% (4/30) treated with VC (p=0.099). Of patients receiving high-dose therapy (≥ 18 grams of piperacillin/tazobactam per day or ≥ 3 grams of cefepime per day), 37.5% (9/24) receiving VPT and 17.6% (3/17) treated with VC developed ARF (p=0.29). A multiple logistic regression analysis identified weight and average vancomycin trough as the only significant predictors of ARF; the choice of VPT as therapy yielded an odds ratio of 3.45 (95% CI 0.96-12.40; p=0.057).
CONCLUSIONS: The authors were unable to detect a statistically significant difference in ARF between groups; however, power was not met. Further study with a larger patient population seems warranted. This article is protected by copyright. All rights reserved.
PMID: 24118354 [PubMed - as supplied by publisher]