Nephrotoxicity of concomitant piperacillin/tazobactam and teicoplanin compared with monotherapy

Abstract

Objectives Piperacillin/tazobactam combined with vancomycin has been associated with a decline in renal function when compared with monotherapy. Teicoplanin is a glycopeptide similar to vancomycin. We investigated whether piperacillin/tazobactam combined with teicoplanin is associated with a decline in renal function as well. Methods We conducted a single-centre retrospective cohort study with data from our electronic health records from 9 August 2013 to 15 November 2019, including all adult patients that received either piperacillin/tazobactam, teicoplanin or piperacillin/tazobactam + teicoplanin. The incidence of acute kidney injury (AKI) at 48–72 h served as the primary outcome, whereas change in serum creatinine served as a secondary outcome. Results Of the 4202 included patients, 3188 (75.9%) received piperacillin/tazobactam, 791 (18.8%) received teicoplanin and 223 (5.3%) received piperacillin/tazobactam + teicoplanin. The incidence of AKI at 48–72 h after commencement of antibiotic therapy was 5.4% for piperacillin/tazobactam, 3.4% for teicoplanin and 11.7% for piperacillin/tazobactam + teicoplanin (P < 0.001). However, mean serum creatinine at 48–72 h was slightly higher in the piperacillin/tazobactam + teicoplanin group therapy compared with baseline [+1.61% (95% CI –2.25 to 5.70)], indicating a slight decrease in renal function, and decreased for piperacillin/tazobactam [–1.98% (95% CI –2.73 to –1.22)] and teicoplanin [–8.01% (95% CI –9.54 to –6.45)]. After correcting for significant confounders in a multivariate linear regression analysis, these patterns remained. Conclusions Our study suggests that piperacillin/tazobactam + teicoplanin is associated with a higher prevalence of AKI compared with monotherapy. However, as the overall decline in renal function with piperacillin/tazobactam + teicoplanin is very small, its clinical relevance is likely limited. Therefore, piperacillin/tazobactam + teicoplanin can probably be safely combined.

Clinical predictors of nephrotoxicity associated with teicoplanin: Meta‐analysis and meta‐regression

“…A previous study indicated that co-administered β-lactam might play an important role in the development of nephrotoxicity associated with teicoplanin. 30 Unfortunately, the present meta-analysis comprised a small number of studies that included patients who had received potential nephrotoxic medications such as piperacillin-tazobactam, aminoglycosides, and calcineurin inhibitors. [31][32][33] Therefore, we could not conduct a meta-regression analysis of these medications.…”

Lowered Risk of Nephrotoxicity through Intervention against the Combined Use of Vancomycin and Tazobactam/Piperacillin: A Retrospective Cohort Study

“…The intervention group in this study showed significantly less nephrotoxicity, which was also observed in the intervention group that only involved patients who replaced VCM with teicoplanin (hazard ratio = 0.460). Recent studies have demonstrated an allowable risk of nephrotoxicity with the teicoplanin and TAZ/PIPC combination but have not reported any outcomes regarding treatment ( 16 , 17 ). Moreover, we have provided the survival rate on day 30 in the entire intervention group, while that in the limited intervention group using teicoplanin (35 patients) was 0.960 (95% CI, 0.836 to 1.102).…”

Potentielle Nephrotoxizität der Kombinationstherapie von Vancomycin und Piperacillin-Tazobactam: Empfehlungen der AG ABS der DGPI unter Beteiligung von Experten der GPN

“…Dabei ist zu bedenken, dass die Bestimmung von Teicoplanin-Talspiegeln bei schweren Infektionen erfolgen soll aber bislang in vielen Kliniken noch nicht in gleichem Maße verfügbar ist [68][69][70][71]. Außerdem ist zu beachten, dass Methicillin-resistente Koagulase-negative Staphylokokken (insbesondere S. haemolyticus) im Vergleich zu Vancomycin eingeschränkt Teicoplanin-sensibel sind [72] und Resistenzraten von 5-13 % vorliegen [73][74][75] ßenordnung aber als klinisch nicht relevant [76]. In einer retrospektiven Studie von Aslan et al ergab der Vergleich der AKI-Rate zwischen P/T + V und P/T + Teicoplanin eine signifikant höhere AKI-Rate in der Patientengruppe, die P/T + V erhielten.…”