Nephrotoxicity of Vancomycin in Combination with Beta-Lactam Agents: Ceftolozane-Tazobactam vs Piperacillin-Tazobactam

Sara Alosaimy, Abdalhamid M. Lagnf, Athena L.V. Hobbs, Musa Mubarez, Wesley D. Kufel, Taylor Morrisette, Radhika S. Polisetty, David Li, Michael P. Veve, Sam P. Simon, James Truong, Natalie Finch, Veena Venugopalan, Matthew Rico, Lee Amaya, Christine Yost, Ashley Cubillos, Elisabeth Chandler, Megan Patch, Ian Murphy Kelsey SmithMark Biagi, Justin Wrin, W. Justin Moore, Kyle C. Molina, Nicholas Rebold, Dana Holger, Ashlan J. Kunz Coyne, Sarah C.J. Jorgensen, Paige Witucki, Nikki N. Tran, Susan L. Davis, George Sakoulas, Michael J. Rybak

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Vancomycin (VAN)-Associated acute kidney injury (AKI) is increased when VAN is combined with certain beta-lactams (BLs) such as piperacillin-Tazobactam (TZP) but has not been evaluated with ceftolozane-Tazobactam (C/T). Our aim was to investigate the AKI incidence of VAN in combination with C/T (VAN/C/T) compared with VAN in combination to TZP (VAN-TZP). Methods: We conducted a multicenter, observational, comparative study across the United States. The primary analysis was a composite outcome of AKI and risk, injury, failure, loss, end stage renal disease; Acute Kidney Injury Network; or VAN-induced nephrotoxicity according to the consensus guidelines. Multivariable logistic regression analysis was conducted to adjust for confounding variables and stratified Kaplan-Meir analysis to assess the time to nephrotoxicity between the 2 groups. Results: We included VAN/C/T (n = 90) and VAN-TZP (n = 284) at an enrollment ratio of 3:1. The primary outcome occurred in 12.2% vs 25.0% in the VAN-C/T and VAN-TZP groups, respectively (P =. 011). After adjusting for confounding variables, VAN-TZP was associated with increased odds of AKI compared with VAN-C/T; with an adjusted odds ratio of 3.308 (95% confidence interval, 1.560-6.993). Results of the stratified Kaplan-Meir analysis with log-rank time-To-nephrotoxicity analysis indicate that time to AKI was significantly shorter among patients who received VAN-TZP (P =. 004). Cox proportional hazards analysis demonstrated that TZP was consistent with the primary analysis (P =. 001). Conclusions: Collectively, our results suggest that the AKI is not likely to be related to tazobactam but rather to piperacillin, which is a component in VAN-TZP but not in VAN-C/T.

Original languageEnglish
Pages (from-to)E1444-E1455
JournalClinical Infectious Diseases
Issue number3
StatePublished - Feb 1 2023

Bibliographical note

Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved.


  • ceftolozane-Tazobactam
  • nephrotoxicity
  • piperacillin-Tazobactam
  • vancomycin

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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