Pediatric acute kidney injury induced by concomitant vancomycin and piperacillin–tazobactam

Abouelkheir, Manal; Alsubaie, Sarah

doi:10.1111/ped.13463

Cited by 18 publications

(19 citation statements)

References 32 publications

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“…In the literature, nephrotoxicity occurs in 1-9% of neonates receiving currently recommended doses, and 6-14% of paediatric patients [19][20][21]. Since these studies were all based on different population, the incidence of VA-AKI cannot be compared.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

et al. 2020

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Background:To study the incidence of vancomycin-associated acute kidney injury (VA-AKI) in Hong Kong and identify risk factors for VA-AKI. Method: Patients with vancomycin prescription and blood level measurement in 2012-2016 were identified using the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System. Acute kidney injury was defined using KDIGO criteria. Patients without creatinine measurements, steady-state trough vancomycin level or who had vancomycin treatment < 3 days were excluded. Results were analyzed using SPSS version 22.0. Logistic regression was used to identify the predictors for VA-AKI. Odds ratio and 95% confidence interval were estimated. Results: One thousand four hundred fifty patients were identified as VA-AKI from 12,758 records in Hong Kong in 2012-2016. The incidence was respectively 10.6, 10.9, 11.3, 12.2, 11.2% from 2012 to 2016. The incidence of VA-AKI was 16.3, 12.2, 11.3 and 6.2% in patients aged 1-12, 12-60, elderly aged > 60 and newborn and infants, respectively. Baseline creatinine, serum trough vancomycin level, systematic disease history including respiratory failure, hypertension, congestive heart failure, chronic renal failure, anemia and type II diabetes, and concomitant diuretics, piperacillin-tazobactam (PTZ) and meropenem prescription were significantly higher in VA-AKI patients older than 12 years. Logistic regression showed that older age group, higher baseline creatinine, serum trough vancomycin level, respiratory failure, chronic renal failure and congestive heart failure, concomitant diuretics, PTZ and meropenem prescription, and longer hospital stay were all associated with increased risk of VA-AKI. Conclusion: The incidence of VA-AKI in Hong Kong is low but shows no decline. Patients with higher baseline creatinine, multi-organ diseases and multiple drugs administration should have their vancomycin level monitored to decrease the risk of VA-AKI.

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Section: Discussionmentioning

confidence: 99%

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

et al. 2020

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“…Adult and pediatric studies suggest that administration of vancomycin and TZP simultaneously confers an increased risk of AKI compared with vancomycin alone, TZP alone, and when compared with use of vancomycin and another b-lactam antibiotic. [8][9][10][11][12][13][14][22][23][24][25][26][27] Assessment of this medication combination has shown varying results in the critically ill population. [28][29][30] Our study is the largest to date that specifically evaluates the association between individual and concomitant administration of vancomycin, TZP, and cefepime with subsequent development of AKI in critically ill children ( Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Piperacillin/Tazobactam and Antibiotic-Associated Acute Kidney Injury in Critically Ill Children

Joyce

Kane‐Gill

Priyanka

et al. 2019

JASN

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BackgroundThere continues to be uncertainty about whether piperacillin/tazobactam (TZP) increases the risk of AKI in critically ill pediatric patients. We sought to compare rates of AKI among critically ill children treated with TZP or cefepime, an alternative frequently used in intensive care units, with and without vancomycin.MethodsWe conducted a retrospective cohort study assessing the risk of AKI in pediatric intensive care unit patients after exposure to vancomycin, TZP, and cefepime, alone or in combination, within 48 hours of admission. The primary outcome was development of stage 2 or 3 AKI or an increase in AKI stage from 2 to 3 within the 6 days after the 48-hour exposure window. Secondary outcomes included lengths of stay, need for RRT, and mortality.ResultsOf 5686 patients included, 494 (8.7%) developed stage 2 or 3 AKI. The adjusted odds of developing AKI after medication exposure were 1.56 for TZP (95% confidence interval [95% CI], 1.23 to 1.99), 1.13 for cefepime (95% CI, 0.79 to 1.64), and 0.86 for vancomycin (95% CI, 0.69 to 1.07). The adjusted odds of developing AKI for vancomycin plus TZP versus vancomycin plus cefepime was 1.38 (95% CI, 0.85 to 2.24).ConclusionsObservational data in critically ill children show that TZP use is associated with increased odds of AKI. A weaker, nonsignificant association between vancomycin plus TZP and AKI compared with vancomycin plus cefepime, creates some uncertainty about the nature of the association between TZP and AKI. However, cefepime is an alternative not associated with AKI.

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“…The concomitant administration of vancomycin and piperacillintazobactam induces acute kidney injury in infants and children [28][29][30]. Vancomycin should not be administered to infants and children who are on piperacillin-tazobactam.…”

Section: Discussionmentioning

confidence: 99%

“…Infants who received vancomycin and piperacillin-tazobactam had a higher cumulative frequency of acute kidney injury than those who received vancomycin and ceftriaxone 915/58 [ Vancomycin is very commonly used in combination with piperacillin-tazobactam as the empiric treatment for moderatesevere infection, whenever coverage for both methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa is required. The combination of vancomycin and piperacillin in adults has been reported to significantly increase the acute risk of acute kidney injury relative to vancomycin monotherapy [29]. A retrospective chart review was conducted of paediatric patients, aged 0-14 years, received vancomycin and piperacillin concomitantly for 48 hours.…”

Section: Concomitant Administration Of Vancomycin and Piperacillintazobactam Induces Acute Kidney Injury In Infants And Childrenmentioning

confidence: 99%

Clinical pharmacology of piperacillin-tazobactam combination in infants and children

Pacifici¹

2019

Clin Med Invest

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Piperacillin is a potent antibiotic and tazobactam is an inhibitor of β-lactamase. Piperacillin-tazobactam combination has a broad spectrum of activity encompassing most gram-positive, gram-negative, aerobic and anaerobic bacteria, including many producing β-lactamase organisms. The dose of piperacillin is 90 mg/kg every 6-8 hours in infants aged 1 month to 1 year. In children, the recommended doses of piperacillin and tazobactam are 50 mg/kg and 6.25 mg/kg or 100 mg/kg and 12.5 mg/kg, respectively, every 6 hours. Piperacillin and tazobactam are mainly excreted as unchanged drugs in the urine, and high biliary concentrations are achieved. The piperacillin elimination half-life is variable in neonates and ranges from 3.5 to 14 hours, whereas in infants aged between 1 and 6 months, the half-life is 47 min. The piperacillin-tazobactam combination is effective, safety, and well tolerated in infants and children. After a single intravenous infusion of 50 mg/kg piperacillin to infants and children aged 1 month to 12 years, the mean plasma concentrations of piperacillin rapidly decayed and were

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Pediatric acute kidney injury induced by concomitant vancomycin and piperacillin–tazobactam

Cited by 18 publications

References 32 publications

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

Piperacillin/Tazobactam and Antibiotic-Associated Acute Kidney Injury in Critically Ill Children

Clinical pharmacology of piperacillin-tazobactam combination in infants and children

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