1382. Acute kidney Injury with Piperacillin-Tazobactam and Vancomycin in the Intensive Care Unit
Session: Poster Abstract Session: PK/PD Studies
Friday, October 5, 2018
Room: S Poster Hall
  • AKI vanc and zosyn IDWeek 2018 poster.pdf (416.9 kB)
  • Background:

    Several recent retrospective studies have suggested that the combination of vancomycin (V) with piperacillin-tazobactam (PTZ) is associated with increased nephrotoxicity.  We prospectively evaluated the outcomes of patients admitted to all of our medical and surgical intensive care units (ICU) with a normal baseline creatinine clearance (CrCl) that received vancomycin in combination with either cefepime (CEF) or PTZ to determine if kidney injury occurs using RIFLE criteria.


    ICU Patients who received combinations of V with either PTZ or CEF were prospectively evaluated from 6/1/17-4/28/18 using Theradoc. V and PTZ dosing were standardized per ICU policy and monitored by clinical pharmacists. We included patients between ages 18 and 90, and receipt of >72 hours of combination antibiotic therapy. We excluded patients that were pregnant, had a hematologic malignancy, chronic kidney disease, or neuromuscular disease. Data collected included, CrCl, V troughs, dosage and length of all antibiotics used, ICU length of stay (LOS), and co-administered nephrotoxic medications (eg, NSAIDs, and IV contrast). The primary objective was to compare the incidence of AKI in these study groups, as defined by the RIFLE criteria.


    Of 233 patients evaluated, 58 (25%) met inclusion criteria, 45 received PTZ-V and 13 CEF-V. Only 8 of 58 (14%) MRSA positive culture.

    Table 1: Data Summary



    P value

    Age (Median, Range)

    58 (35-84)

    64 (18-79)


    Gender (male)

    30 (67%)

    7 (54%)


    Median Weight (kg)

    86 (54-136)

    82.4 (51-156)


    No > 100 kg

    11 (24%)

    3 (23%)


    No V trough >20

    2 (4%)

    1 (8%)


    Median V  trough (range)

    11.4 (5.4-32.7)

    10.6 (6.4-29.5)


    Median V days (range)

    5 (3-16)

    4 (3-13)


    Co-admin Nephrotoxic agent

    41 (91%)

    11 (85%)



    11 (4-36)

    14 (3-32)


    Hospital LOS

    15 (4-36)

    20 (6-72)


    No. AKI by RIFLE




    We found no correlation with co-administered nephrotoxic agents, vancomycin troughs, or body weight and AKI.


    Our prospective observational study data revealed significant AKI with PTZ-V compared to CEF-V but it did not impact patient long term outcomes. Caution with PTZ-V may be required when used in ICU settings even in patients with normal baseline CrCl..

    Tameka Smith, MS, Oregon health and Science University, Portland, OR, James Lewis, PharmD, FIDSA, Department of Pharmacy, Oregon Health & Science University, Portland, OR and Graeme N. Forrest, MBBS, FIDSA, Dept of Medicine, Portland Veterans Administration Medical Center, Portland, OR; Section of Infectious Disease, Department of Medicine, Oregon Health & Science University, Portland, OR


    T. Smith, None

    J. Lewis, Merck: Consultant , Consulting fee .

    G. N. Forrest, None

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