Acute Kidney Injury in Patients on Concomitant Vancomycin and Piperacillin/Tazobactam: Are Extended Infusions to Blame?

Incidence of Acute Kidney Injury Among Patients Receiving the Combination of Vancomycin with Piperacillin‐Tazobactam or Meropenem

“…The primary outcome of these studies revealed a significantly higher incidence of AKI in the VAN/PTZ group when compared with the VAN/CEF group (34.8% vs 12.5%; p<0.0001, and 29% vs 11%; p<0.0001, respectively). Similar to our study, both identified VAN/PTZ as an independent risk factor for developing AKI (OR 5.67 and hazard ratio 4.27, respectively) . One report did not detect any significant differences in hospital length of stay between study groups .…”

“…Our study revealed similar results. In contrast, the second study observed a longer hospital stay for patients receiving VAN/PTZ (8 vs 6 days; p=0.01) . This study also demonstrated a significantly faster onset of AKI in the VAN/PTZ group compared with the VAN/CEF group (3 vs 5 days; p<0.0001), while the other cited study did not detect any significant differences in time to AKI .…”

“…Most studies included in published meta‐analyses assessed the combination of VAN/PTZ versus VAN alone or VAN/CEF. Specifically, two reports compared the incidence of AKI in critically and acutely ill patients receiving VAN/PTZ compared with those receiving VAN/CEF . The primary outcome of these studies revealed a significantly higher incidence of AKI in the VAN/PTZ group when compared with the VAN/CEF group (34.8% vs 12.5%; p<0.0001, and 29% vs 11%; p<0.0001, respectively).…”

“…The following were exclusion criteria: transfer to Mercy Hospital Northwest Arkansas from an outside hospital, pregnancy, admission to the intensive care unit during administration or within 72 hours of completing the antibiotics, administration of nephrotoxic antibiotics (Table in the Supporting Information) within 72 hours before initiation of the study antibiotics, administration of PTZ and MER within 72 hours of one another, a diagnosis of AKI within the 72‐hour period before the initiation of the study antibiotics, and renal dysfunction at the time of study antibiotic initiation. Other trials defined AKI as an increase in S cr within 24–72 hours of drug exposure . Renal dysfunction was defined as a Cl cr lower than 30 ml/minute using the S cr level drawn within 24 hours before starting the antibiotics, receipt of hemodialysis, or presence of structural kidney disease.…”

“…In addition, there are conflicting data regarding the risk of AKI when VAN is combined with an antipseudomonal β‐lactam. Several studies showed an increased risk of AKI when VAN is given in combination with PTZ . Most of these studies assessed the risk of AKI in patients receiving VAN/PTZ versus VAN monotherapy or VAN/cefepime (CEF).…”