Incidence of acute kidney injury in patients receiving vancomycin and pipercillin-tazobactam compared to other antibiotic combinations
Background: Vancomycin and piperacillin-tazobactam are two of the most commonly used empiric antibiotics in hospitalized patients. Recent reports indicate a higher incidence of acute kidney injury (AKI) with this combination of antimicrobial compared with vancomycin alone
Methods: Retrospective chart review of patients admitted to tertiary medical center receiving at least 48 hours of vancomycin (V), piperacillin-tazobactam (Z), vancomycin and piperacillin-tazobactam (VZ), vancomycin and doripenem (VD) and piperacillin-tazobactam and daptomycin (ZD) for rates of AKI. AKI was defined as an increase in creatinine by 50% from baseline or ≥ 0.5 mg/dL. Other data collected included vancomycin level, vasopressor use, diabetes mellitus (DM) history, nephrotoxic agents and concurrent contrast.
Results: Data of 392 patients over a period of 2 years were analyzed. Average age in each group was: V (66), Z (67), VZ (63), ZD (58) and VD (61). Average initial creatinine in all groups was 1.1 mg/dL. AKI developed in 28% (26/94) of patients in the VZ group, 7% (3/44) of vancomycin alone, 8% (8/101) of pipercillin-tazobactam alone, 12% (12/100) of patients receiving VD and 9% (5/53) of those on ZD . Within the VZ and ZD group, those who develop AKI, was more likely be on diuretics and or ACE inhibitors. Concurrent contrast did not seem to correlate with AKI in any of the groups except for vancomycin alone group. Vancomycin trough level was higher in those with AKI in the VZ group and vancomycin alone group. Vasopressors were more likely used in the AKI group with all the combinations. DM reported more in Z, VZ, VD groups in those who developed AKI. The average patient age was higher in the AKI subset in all groups except for VZ and VD group. In VZ group, the average time to onset of AKI was 7.6 days.
Conclusion: Higher Rates of acute kidney injury seen in patients with combination of pipercillian-tazobactam and vancomycin. In addition, any two antibiotics combination had higher incidence of AKI in compare when vancomycin or pipercillin-tazobactam used alone. The risk of AKI may be higher in patients on concurrent diuretics, ACE inhibitors and those with diabetes mellitus. Further studies needed to confirm these results and to evaluate mechanism of nephrotoxicity.
F. Ibrahim, None
S. Lindquist, None
A. Mameli, None
S. Jones, None
A. Anderson, None