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Acute kidney injury in patients treated with IV beta-lactam/beta-lactamase inhibitor combinations.
Pharmacotherapy. 2017 Mar 01;:
Authors: Rutter WC, Burgess DS
Abstract
STUDY OBJECTIVE: Increased acute kidney injury (AKI) incidence has been reported in patients receiving piperacillin-tazobactam (PTZ) therapy compared to other beta-lactams. This study sought to determine if the addition of beta-lactamase inhibitors impact AKI incidence by comparing patients treated with PTZ or ampicillin-sulbactam (SAM).
DESIGN: Retrospective cohort study.
SETTING: Large academic tertiary care hospital.
PATIENTS: Overall, 2,448 patients received PTZ (n=1,836) or SAM (n=612) for at least 48 hours between September 1, 2007 and September 30, 2015. Patients were excluded for pregnancy, cystic fibrosis, chronic kidney disease, and initial creatinine clearance (CrCl) < 30 mL/min. Patients were matched on Charlson Comorbidity Index (CCI), initial CrCl, hypotension exposure, various nephrotoxic drug exposures, history of diabetes, heart failure, and hypertension.
MEASUREMENTS AND MAIN RESULTS: AKI occurred in 265 patients at similar rates for both groups (PTZ 11.4% vs SAM 9.2%; p=0.14). After stratifying by vancomycin exposure and controlling for confounders, there was no difference in the risk of AKI for SAM or PTZ (adjusted OR 0.87, 95% CI 0.59-1.25). The addition of vancomycin to PTZ increased the likelihood of AKI compared to PTZ alone (adjusted OR 1.77, 95% CI 1.26-2.46). Concomitant SAM and VAN therapy was not associated with a significant increase in AKI compared to SAM monotherapy (adjusted OR 1.01, 95% CI 0.48-1.97).
CONCLUSION: Rates of AKI were similar for PTZ and SAM in a matched cohort. The addition of a beta-lactamase inhibitor is not likely the mechanism in the observed increased rates of AKI in patients treated with vancomycin and PTZ. This article is protected by copyright. All rights reserved.
PMID: 28247443 [PubMed - as supplied by publisher]