Comparative incidence and excess risk of acute kidney injury in hospitalized patients receiving vancomycin and piperacillin-tazobactam in combination or as monotherapy.
Int J Antimicrob Agents. 2018 Aug 10;:
Authors: Carreno JJ, Smiraglia T, Hunter C, Tobin E, Lomaestro B
INTRODUCTION: Combination therapy with vancomycin and piperacillin-tazobactam has been associated with increased risk of acute kidney injury (AKI) as compared to monotherapy. This study was conducted to assess the comparative incidence of AKI due to combination therapy in patients receiving vancomycin and piperacillin-tazobactam in combination or as monotherapy.
METHODS: Retrospective, matched, cohort study of patients receiving vancomycin and piperacillin-tazobactam in combination or as monotherapy. Patients who were aged ≥ 18, admitted to Albany Medical Center between 9/1/2013 and 8/31/2014, and who had received therapy for at least two consecutive days were included. Patients who were pregnant, neutropenic, had AKI on admission, or had cystic fibrosis were excluded. Patients were matched on a baseline AKI risk. The main outcome of interest was AKI defined as an increase in SCr of 0.3 mg/L or 50% within 48 hours. Secondary outcomes evaluated were hospital length of stay, ICU length of stay, and inpatient mortality associated with AKI.
RESULTS: The risk of AKI was 7.0%, 8.5%, and 26.8% in the vancomycin monotherapy, piperacillin-tazobactam monotherapy, and combination groups, respectively (P < 0.001). In the multivariate analysis, combination therapy was independently associated with increased odds of AKI (aOR [95% CI]: 4.406 [1.472 - 13.188]) as compared to vancomycin monotherapy. The excess risk of combination therapy was 11.2%.
CONCLUSIONS: In this matched cohort study, there was an increased incidence of AKI in patients receiving vancomycin and piperacillin-tazobactam combination therapy. Further research is needed to determine the individual elucidate strategies to best prevent inpatient AKI in patients receiving this combination therapy.
PMID: 30103003 [PubMed - as supplied by publisher]