Amy D Robertson1,2, Chenghui Li3, Drayton A Hammond4, Tiffany A Dickey1,2. 1. Department of Pharmacy Practice, University of Arkansas for Medical Sciences Northwest Regional Campus, Fayetteville, Arkansas. 2. Mercy Hospital Northwest Arkansas, Rogers, Arkansas. 3. Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, Arkansas. 4. Medical and Cardiac Intensive Care, Rush University Medical Center, Chicago, Illinois.
Abstract
INTRODUCTION: Vancomycin (VAN) is associated with an increased risk of acute kidney injury (AKI). Evidence is conflicting regarding the risk of AKI when VAN is combined with an antipseudomonal β-lactam. OBJECTIVES: To determine the comparative incidence of AKI when VAN is combined with piperacillin-tazobactam (PTZ) or meropenem (MER). METHODS: This was a retrospective cohort study of acutely ill adults receiving the combination of VAN and PTZ or MER for at least 48 hours between November 1, 2014, and October 31, 2016, in a tertiary care hospital. Critically ill patients and those with baseline renal dysfunction were excluded. The primary outcome was the incidence of AKI during or within 72 hours of completing antibiotic therapy, defined as an absolute increase in serum creatinine (Scr ) of 0.5 mg/dl or higher or a 50% or more increase in Scr from baseline. Secondary outcomes included time to AKI development, duration of AKI, and length of hospitalization. Continuous variables were assessed using the Wilcoxon rank sum or the Student t test; categorical variables were assessed using χ2 or Fisher exact tests. Independent risk factors for the development of AKI were also examined. RESULTS: A total of 169 patients were evaluated. A significantly higher incidence of AKI was observed in the PTZ group compared with MER (16.5% vs 3.6%; p=0.009). The median time to AKI onset was significantly shorter with PTZ compared with MER (3 vs 7 days; p=0.009). After adjusting for baseline differences, VAN/PTZ was associated with a 6.8-fold increased risk of developing AKI (odds ratio [OR] 6.8, 95% confidence interval [CI] 1.5-30.9) compared with VAN/MER. VAN doses higher than 4 g/day and trough levels higher than 20 μg/ml were independent risk factors for developing AKI (OR 8.7, 95% CI 1.04-72.94, and OR 9.01, 95% CI 1.44-56.21, respectively). CONCLUSION: The combination of VAN/PTZ increases the risk of AKI when compared with VAN/MER in acutely ill adults.
INTRODUCTION:Vancomycin (VAN) is associated with an increased risk of acute kidney injury (AKI). Evidence is conflicting regarding the risk of AKI when VAN is combined with an antipseudomonal β-lactam. OBJECTIVES: To determine the comparative incidence of AKI when VAN is combined with piperacillin-tazobactam (PTZ) or meropenem (MER). METHODS: This was a retrospective cohort study of acutely ill adults receiving the combination of VAN and PTZ or MER for at least 48 hours between November 1, 2014, and October 31, 2016, in a tertiary care hospital. Critically illpatients and those with baseline renal dysfunction were excluded. The primary outcome was the incidence of AKI during or within 72 hours of completing antibiotic therapy, defined as an absolute increase in serum creatinine (Scr ) of 0.5 mg/dl or higher or a 50% or more increase in Scr from baseline. Secondary outcomes included time to AKI development, duration of AKI, and length of hospitalization. Continuous variables were assessed using the Wilcoxon rank sum or the Student t test; categorical variables were assessed using χ2 or Fisher exact tests. Independent risk factors for the development of AKI were also examined. RESULTS: A total of 169 patients were evaluated. A significantly higher incidence of AKI was observed in the PTZ group compared with MER (16.5% vs 3.6%; p=0.009). The median time to AKI onset was significantly shorter with PTZ compared with MER (3 vs 7 days; p=0.009). After adjusting for baseline differences, VAN/PTZ was associated with a 6.8-fold increased risk of developing AKI (odds ratio [OR] 6.8, 95% confidence interval [CI] 1.5-30.9) compared with VAN/MER. VAN doses higher than 4 g/day and trough levels higher than 20 μg/ml were independent risk factors for developing AKI (OR 8.7, 95% CI 1.04-72.94, and OR 9.01, 95% CI 1.44-56.21, respectively). CONCLUSION: The combination of VAN/PTZ increases the risk of AKI when compared with VAN/MER in acutely ill adults.
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