Comparison of acute kidney injury risk associated with vancomycin and concomitant piperacillin/tazobactam or cefepime in the intensive care unit

Buckley, Mitchell S.; Hartsock, Nicole C.; Berry, Andrew; Bikin, Dale S.; Richards, Emily C.; Yerondopoulos, Melanie; Kobic, Emir; Wicks, Laura M.; Hammond, Drayton A.

doi:10.1016/j.jcrc.2018.08.007

Cited by 46 publications

(57 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Systematic review and meta‐analyses had been published on the topic prior to this survey, which have suggested that the ORs in acutely ill patients were approximately three and there were no differences in AKI development in critically ill patients . Subsequent data have been published that support these findings . Respondents may have perceived that critically ill patients experience AKI more frequently than acutely ill patients and extrapolated this thought to the combination VPT phenomenon .…”

Section: Discussionmentioning

confidence: 91%

“…However, a meta‐analysis by Luther et al found a nonsignificant difference in time to AKI (mean difference 1.30 days sooner with combination VPT, 95% CI −3.00 to 0.41 days) . More recent studies observed similar times to AKI in shorter and longer courses of combination therapies, respectively . In each of these studies, the majority of patients who developed AKI did so between 72 hours and 7 days of initiation.…”

Section: Discussionmentioning

confidence: 98%

“…Respondents perceived that approximately half of patients who developed AKI from combination VPT would require RRT or progress to CKD, though one‐quarter were unsure of this rate of disease progression. These perceptions likely reflect the challenges of assessing this outcome because many patients in these studies were not followed after hospital discharge, expired while receiving the combination, and had other potential etiologies of progression of their renal dysfunction, which led most studies to not reporting this outcome . Consequently, neither of the meta‐analyses published at the time analyzed this outcome because of the dearth of available data .…”

Section: Discussionmentioning

confidence: 99%

“…A recently recognized, albeit controversial, cause of AKI is the combination of vancomycin and piperacillin/tazobactam (VPT) . Initial studies observed the association in acutely ill patients, though data in critically ill patients found no such association .…”

Section: Introductionmentioning

confidence: 99%

“…Recent meta‐analyses have continued to suggest that the association exists in the acutely ill (adjusted odds ratio [aOR] 3.04, 95% confidence interval [CI] 1.49‐6.22) but not in the critically ill (aOR 2.83, 95% CI 0.74‐10.85 and OR 1.32, 95% CI 0.73‐2.38) . Subsequently, multiple variables have been investigated in observational studies to determine their predictive or confounding natures …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Pharmacists' perceptions and practice changes resulting from emergence of the vancomycin‐piperacillin/tazobactam nephrotoxicity phenomenon

Hammond

Trivedi

Esmero

et al. 2019

J Am Coll Clin Pharm

Self Cite

View full text Add to dashboard Cite

Purpose To elucidate the considerations pharmacists have when using concomitant vancomycin and piperacillin/tazobactam (VPT) and strategies implemented across hospitals in response to published data on this phenomenon. Methods A survey of pharmacist members of the infectious diseases and critical care (CC) practice and research networks of the American College of Clinical Pharmacy was conducted. Participants were grouped based on their belief (yes or no) in the association between VPT and acute kidney injury (AKI) and queried regarding AKI with VPT, antimicrobial stewardship practices, and demographics. Descriptive statistics were performed. Between‐group responses were compared using χ2 or Fisher's exact tests. Results There were 238 responses. Most (88.7%) respondents believed combination VPT is associated with greater expected odds of AKI development than vancomycin monotherapy or with cefepime. Nonbelievers more commonly practiced in CC or emergency medicine (P = .006) and less frequently recommended the combination in patients already experiencing AKI (64% vs 7.4%, P < .001) and in patients with chronic kidney disease class III or IV (56.9% vs 3.7%, P < .001). Opinions varied regarding risk factors for and odds of AKI development in specific scenarios. Respondents who believed combination VPT is associated with greater odds of AKI development more frequently provided formal (18% vs 0, P = .01) and informal (73% vs 33.3%, P < .001) education on potential AKI from combination VPT and discouraged empiric combination VPT in favor of other combination(s) (40.8% vs 14.8%, P = .01). Other AMS strategies were used to a similar extent regardless of belief in the association of VPT with AKI. Conclusion Most respondents, particularly those practicing in CC and emergency medicine, believe combination VPT is associated with AKI development. These beliefs have affected antimicrobial recommendations and educational efforts. The impact of these beliefs on patient outcomes and health care expenditures requires further investigation.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Pharmacists' perceptions and practice changes resulting from emergence of the vancomycin‐piperacillin/tazobactam nephrotoxicity phenomenon

Hammond

Trivedi

Esmero

et al. 2019

J Am Coll Clin Pharm

Self Cite

View full text Add to dashboard Cite

show abstract

Updates on pediatric sepsis

et al. 2020

View full text Add to dashboard Cite

Sepsis, defined as an infection with dysregulated host response leading to life‐threatening organ dysfunction, continues to carry a high potential for morbidity and mortality in children. The recognition of sepsis in children in the emergency department (ED) can be challenging, related to the high prevalence of common febrile infections, poor specificity of discriminating features, and the capacity of children to compensate until advanced stages of shock. Sepsis outcomes are strongly dependent on the timeliness of recognition and treatment, which has led to the successful implementation of quality improvement programs, increasing the reliability of sepsis treatment in many US institutions. We review clinical, laboratory, and technical modalities that can be incorporated into ED practice to facilitate the recognition, treatment, and reassessment of children with suspected sepsis. The 2020 updated pediatric sepsis guidelines are reviewed and framed in the context of ED interventions, including guidelines for antibiotic administration, fluid resuscitation, and the use of vasoactive agents. Despite a large body of literature on pediatric sepsis epidemiology in recent years, the evidence base for treatment and management components remains limited, implying an urgent need for large trials in this field. In conclusion, although the burden and impact of pediatric sepsis remains substantial, progress in our understanding of the disease and its management have led to revised guidelines and the available data emphasizes the importance of local quality improvement programs.

show abstract

Acute kidney injury risk with piperacillin‐tazobactam and vancomycin combination therapy: single centre retrospective study

McLaren

Banakh

Cam

et al. 2020

Pharmacy Practice and Res

View full text Add to dashboard Cite

Aim: To evaluate the risk of acute kidney injury (AKI) in patients who receive vancomycin (VNC) and piperacillin-tazobactam (PTZ) combination therapy. Method: A single centre, retrospective audit of adult patients treated with VNC alone and in combination with PTZ between 2014-2015. Data was extracted from digital medical records and therapeutic drug monitoring sheets completed by clinical pharmacists. Rates of AKI and duration of combination therapy were analysed by chi-square, with logistic regression analysis completed to control for nephrotoxins, intensive care unit admission, use of inotropes and pre-existing chronic kidney disease. Results: Out of 525 vancomycin courses, that met the inclusion criteria, 211 had PTZ co-prescribed during the study period. Combination therapy was significantly both associated with an increased rate of AKI compared to VNC use alone (17.5% vs 10.5%, P = 0.02). The mean duration of combination therapy was 4 days (1-17 days). Increased duration of exposure to combination therapy was also associated with a higher incidence of AKI (3.8 days vs. 5.2 days, P = 0.014). VNC-TPZ combination was identified to be an independent risk factor for AKI (OR 1.73, 95% CI 1.01-2.96, P = 0.046) after adjusting for other known risk factors for AKI, including vasopressor use and intensive care unit admission. Conclusion: Combined use of VNC-PTZ, as well as the duration of combination therapy are both associated with an increased risk of AKI compared with VNC alone. The results are similar to previous literature reports of AKI from the combination of antibiotics. Healthcare providers need to be vigilant and limit the exposure to this combination as clinically appropriate.

show abstract

Comparison of acute kidney injury risk associated with vancomycin and concomitant piperacillin/tazobactam or cefepime in the intensive care unit

Cited by 46 publications

References 29 publications

Pharmacists' perceptions and practice changes resulting from emergence of the vancomycin‐piperacillin/tazobactam nephrotoxicity phenomenon

Pharmacists' perceptions and practice changes resulting from emergence of the vancomycin‐piperacillin/tazobactam nephrotoxicity phenomenon

Updates on pediatric sepsis

Acute kidney injury risk with piperacillin‐tazobactam and vancomycin combination therapy: single centre retrospective study

Contact Info

Product

Resources

About