Abstract
Recent reports have demonstrated that vancomycin (VAN) may lead to an increase in the incidence of acute kidney injury (AKI) when it is combined with antipseudomonal beta-lactams. This study compared the incidence of AKI associated with VAN plus piperacillin-tazobactam (TZP) or cefepime (FEP). This was a retrospective, matched cohort study that was conducted at an academic medical center between September 2010 and September 2014 and that included adult patients without severe chronic or structural kidney disease, dialysis, pregnancy, cystic fibrosis, or a hospital transfer receiving TZP-VAN or FEP-VAN for at least 48 h. The primary outcome was the difference in the AKI incidence between the TZP-VAN and FEP-VAN groups, evaluated using the risk, injury, failure, loss of kidney function, and end-stage kidney disease (RIFLE) criteria. Patients in the two groups were matched on the basis of age, sex, severity of illness, baseline creatinine clearance, hypotension, number of nephrotoxicity risk factors, and intravenous contrast exposure. In total, 4,193 patients met all inclusion criteria (3,605 received TZP-VAN and 588 received FEP-VAN). The unadjusted AKI incidence was 21.4% in patients receiving TZP-VAN, whereas it was 12.6% in patients receiving FEP-VAN (P < 0.001). After the patients were matched, 1,633 patients receiving TZP-VAN and 578 patients receiving FEP-VAN were evaluated. The AKI incidence remained higher in patients receiving TZP-VAN than in those receiving FEP-VAN (21.4% versus 12.5%, P < 0.0001). This trend remained true for all classifications of the RIFLE criteria. After controlling for remaining confounders, TZP-VAN therapy was associated with 2.18 times the odds of AKI than FEP-VAN therapy (95% confidence interval, 1.64 to 2.94 times) in logistic regression. AKI was significantly more common in patients receiving vancomycin in combination with piperacillin-tazobactam than in those receiving vancomycin in combination with cefepime. This finding reinforces the need for the judicious use of combination empirical antimicrobial therapy.
| Original language | English |
|---|---|
| Article number | e02089 |
| Journal | Antimicrobial Agents and Chemotherapy |
| Volume | 61 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2017 |
Bibliographical note
Publisher Copyright:© 2017 American Society for Microbiology. All Rights Reserved.
Funding
We have no conflicts of interest to disclose in relation to the study presented here. The project described here was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through grant numbers UL1TR000117 and UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The sponsors did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. W.C.R. and D.S.B. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
| Funders | Funder number |
|---|---|
| National Institutes of Health (NIH) | |
| National Center for Advancing Translational Sciences (NCATS) | UL1TR001998, UL1TR000117 |
Keywords
- Adverse drug effects
- Beta-lactams
- Cefepime
- Nephrotoxicity
- Piperacillin-tazobactam
- Vancomycin
ASJC Scopus subject areas
- Pharmacology
- Pharmacology (medical)
- Infectious Diseases
