Incidence of acute kidney injury among patients receiving the combination of vancomycin with piperacillin-tazobactam or meropenem.

Link to article at PubMed

Related Articles

Incidence of acute kidney injury among patients receiving the combination of vancomycin with piperacillin-tazobactam or meropenem.

Pharmacotherapy. 2018 Sep 02;:

Authors: Robertson AD, Li C, Hammond D, Dickey TA

Abstract
INTRODUCTION: Vancomycin (VAN) is associated with an increased risk of acute kidney injury (AKI). There is conflicting evidence regarding the risk of AKI when VAN is combined with an anti-pseudomonal beta-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 (SCr) of ≥0.5 mg/dL or ≥50% increase in SCr from baseline. Secondary outcomes included time to AKI development, duration of AKI, and length of hospitalization. Continuous variables were assessed using Wilcoxon rank-sum or Student's t-test while categorical variables were assessed using Chi-square or Fisher's exact tests. Independent risk factors for the development of AKI were also examined.
RESULTS: A total of 169 patients were evaluated. There was a significantly higher incidence of AKI in the PTZ group compared to MER (16.5% vs 3.6%; p=0.009). The median time to AKI onset was significantly shorter with PTZ compared to MER (3 vs 7 days; p=0.009). After adjusting for baseline differences, VAN/PTZ was associated with 6.8-fold increased risk of developing AKI (OR 6.8; 95% CI 1.5-30.9) compared to VAN/MER. VAN doses >4 g/day and trough levels >20 mcg/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 to VAN/MER in acutely ill adults. This article is protected by copyright. All rights reserved.

PMID: 30175410 [PubMed - as supplied by publisher]

Leave a Reply

Your email address will not be published. Required fields are marked *