Matthew Blair1, Jean-Maxime Côté2,3, Aoife Cotter4, Breda Lynch5, Lynn Redahan1,6, Patrick T Murray7,8,9. 1. Division of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland. 2. Service of Nephrology, Department of Medicine, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada. 3. Clinical Research Centre, University College Dublin, Dublin, Ireland. 4. Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland. 5. Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland. 6. Department of Renal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland. 7. Division of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland, patrick.murray@ucd.ie. 8. Clinical Research Centre, University College Dublin, Dublin, Ireland, patrick.murray@ucd.ie. 9. Department of Renal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland, patrick.murray@ucd.ie.
Abstract
BACKGROUND: Recent studies have identified the combination of vancomycin with piperacillin-tazobactam (VPT) to be associated with increased nephrotoxicity. Multiple, large cohort studies have found this widely used combination to have a higher risk of nephrotoxicity than other regimens in a variety of populations. SUMMARY: This review summarizes the epidemiology and clinical features of VPT-associated acute kidney injury (AKI). Potential mechanisms involved in the pathogenesis of this phenomenon are also discussed. Key Message: VPT-associated nephrotoxicity is a recently recognized clinical entity. Clinical strategies to minimize the risk of toxicity in this setting include antimicrobial stewardship, monitoring of kidney function, and emerging data supporting the potential role for novel biomarkers in predicting and managing AKI.
BACKGROUND: Recent studies have identified the combination of vancomycin with piperacillin-tazobactam (VPT) to be associated with increased nephrotoxicity. Multiple, large cohort studies have found this widely used combination to have a higher risk of nephrotoxicity than other regimens in a variety of populations. SUMMARY: This review summarizes the epidemiology and clinical features of VPT-associated acute kidney injury (AKI). Potential mechanisms involved in the pathogenesis of this phenomenon are also discussed. Key Message: VPT-associated nephrotoxicity is a recently recognized clinical entity. Clinical strategies to minimize the risk of toxicity in this setting include antimicrobial stewardship, monitoring of kidney function, and emerging data supporting the potential role for novel biomarkers in predicting and managing AKI.
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