Impact of Piperacillin/Tazobactam on Nephrotoxicity in Patients with Gram-negative Bacteremia.
Int J Antimicrob Agents. 2018 Nov 08;:
Authors: Hall RG, Yoo E, Faust A, Smith T, Goodman E, Mortensen EM, Raza J, Dehmami F, Alvarez CA
Piperacillin/tazobactam has been associated with nephrotoxicity in patients receiving vancomycin. Its impact on nephrotoxicity in patients with gram-negative bacteremia (GNB) is unclear. This study aims to evaluate piperacillin/tazobactam's impact on nephrotoxicity in patients with GNB. Our retrospective cohort included patients ≥18 years of age who received ≥48 hours of therapy for bacteremia due to Escherichia coli, Pseudomonas aeruginosa, Enterobacter sp., Klebsiella sp., Acinetobacter sp., or Stenotrophomonas maltophila from 1/1/2008-8/31/2011. Patients with a baseline serum creatinine (SCr) ≥3.5 mg/dL, polymicrobial infection, or recurrent bacteremia were excluded. Nephrotoxicity was defined as a ≥0.5 mg/dL increase in SCr or ≥50% increase from baseline for ≥2 consecutive days. Any variable demonstrating a 10% change in the exposure effect was kept in the final model. All variables biologically reasonable causes of nephrotoxicity were also considered for inclusion. The median age of the cohort (n = 292) was 76 years and 38% had a cancer diagnosis. ICU residence was also common (22%) upon the identification of the GNB. There was no difference in nephrotoxicity incidence based on days of piperacillin/tazobactam received (0d: 13.6%, 1-2d: 14.7%, 3-4d: 6.9%, 5+d: 16.7%; p = 0.71). In the multivariable analysis, baseline SCr, total body weight, and vasopressor use were independently associated with nephrotoxicity. Duration of piperacillin/tazobactam therapy was not associated with nephrotoxicity in the multivariable (1-2d: OR 0.91, 95% CI 0.39-2.12; 3-4d: OR 0.48, 95%CI 0.10-2.46; 5+d: OR 0.57, 95%CI 0.11-3.02) analysis. In our cohort of patients with bacteremia, the duration of piperacillin/tazobactam was not associated with nephrotoxicity.
PMID: 30415001 [PubMed - as supplied by publisher]