Short Versus Extended Duration Vancomycin and Piperacillin/Tazobactam and the Incidence of Acute Kidney Injury in Noncritically Ill Patients

Abstract

Background: Vancomycin plus piperacillin-tazobactam (VPT) is a commonly used empiric combination of antimicrobials. Recently, studies have demonstrated an increase in acute kidney injury (AKI) associated with combination therapy of VPT. However, the majority of studies required patients to be on VPT for a minimum of 48 to 72 hours to be considered for inclusion and had extended treatment durations longer than most empiric, short course regimens. Objective: To assess the incidence of AKI in noncritically ill patients being treated with VPT for short-courses (24 to 60 hours) compared to patients receiving extended-courses (72 hours to 7 days). Methods: This was a retrospective cohort study comparing the incidence of AKI in noncritically ill patients receiving VPT for short and extended durations between January 2016 and August 2018. Fishers exact tests were used for differences in nominal data between groups and Mann-Whitney U tests were used for continuous data. Results: Of the 2567 screened, 154 patients were included in the short-course group and 106 were included in the extended-course group. The incidence of AKI for patients in the short-course group was 12% (19/154) versus 26% (28/106) in the extended-course group (odds ratio: 2.55, 95% CI: 1.33-4.87; P = .004). Conclusion: In noncritically ill patients, a short-course of VPT experienced less AKI compared to an extended-course. Clinicians should continue to practice strict antimicrobial stewardship for VPT therapies expected to continue beyond 72 hours.

Assessment of knowledge, attitude, and practices of acute kidney injury incidence with co-administration of piperacillin/tazobactam and vancomycin among healthcare workers: A cross-sectional study

“…Our study showed that physicians tend to take required protective measures when using VPT more than pharmacists and nurses (p = 0.042). The protective measures included implementing an antimicrobial stewardship program, receiving the shortest recommended duration of VPT, as AKI risk was reduced by a shorter duration, and identifying all nephrotoxic medications and monitoring kidney functions closely ( Blair et al, 2021 , Traversa et al, 2021 ). In order to ensure the protective measures are followed, our study recommended developing institutional guidelines for VPT monitoring and utilization and implementing regulations and policies that restrict the prescribing of VPT to specialized physicians to ensure safe medication use.…”

Piperacillin–Tazobactam Plus Vancomycin-Associated Acute Kidney Injury in Adults: Can Teicoplanin or Other Antipseudomonal Beta-Lactams Be Remedies?

“…As a result, the authors demonstrated that a short course of TZP–VAN therapy did not confer a higher risk of stage II or III AKI after adjustment for relevant confounders (adjusted odds ratio [95% confidence interval] TZP–VAN vs. FEP–VAN, 1.11 [0.85–1.45]; TZP–VAN vs. MER–VAN, 1.04 [0.71–1.42]). Similarly, a retrospective single-center cohort study indicated that a short-course TZP–VAN regimen (24–60 h) was significantly associated with a lower risk of AKI as compared with extended-course TZP–VAN (>72 h) therapy [ 52 ]. Consequently, antimicrobial stewardship practices minimizing administration of TZP–VAN beyond 72 h seem to be plausible.…”