Mitchell S Buckley1, Ivan A Komerdelj2, Paul A D'Alessio3, Pooja Rangan4, Sumit K Agarwal5, Nicole C Tinta6, Brandon K Martinez7, Delia S Ziadat8, Melanie J Yerondopoulos9, Emir Kobic10, Sandra L Kane-Gill11. 1. Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA. Electronic address: mitchell.buckley@bannerhealth.com. 2. Department of Pharmacy, Banner MD Anderson Cancer Center, 2946 E. Banner Gateway Dr, Gilbert, AZ 85234, USA. Electronic address: ivan.komerdelj@bannerhealth.com. 3. Department of Pharmacy, Banner Baywood Medical Center, 6644 E. Baywood Ave., Mesa, AZ 85206, USA. Electronic address: p-dalessio@onu.edu. 4. Department of Medicine, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA. Electronic address: Pooja.Rangan@bannerhealth.com. 5. Department of Medicine, University of Arizona-College of Medicine Phoenix, 550 E Van Buren Street, Phoenix, AZ 85004, USA. Electronic address: Sumit.Agarwal@bannerhealth.com. 6. Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA. Electronic address: Nicole.Tinta@bannerhealth.com. 7. Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA. Electronic address: Brandon.Martinez@bannerhealth.com. 8. Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA. Electronic address: Delia.Ziadat@bannerhealth.com. 9. Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA. Electronic address: Melanie.Yerondopoulos@bannerhealth.com. 10. Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA. Electronic address: Emir.Kobic@bannerhealth.com. 11. Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA. Electronic address: kane-gill@pitt.edu.
Abstract
PURPOSE: The risk of acute kidney injury (AKI) associated with concomitant vancomycin and piperacillin/tazobactam in the intensive care unit (ICU) remains controversial. The aim of this study was to compare the AKI incidence associated with concomitant vancomycin and piperacillin/tazobactam compared to either cefepime or meropenem with vancomycin in the ICU. MATERIALS AND METHODS: A multicenter, retrospective, propensity score-matched cohort study was conducted in adult ICU patients administered vancomycin in combination with either piperacillin/tazobactam, cefepime, or meropenem were included. Patients developing AKI ≤48 h following combination therapy initiation were excluded. The primary endpoint was to compare the incidence of AKI associated with concomitant antimicrobial therapy. Multivariable Cox regression modeling in predicting AKI was also conducted. RESULTS: A total of 1044 patients were matched. The AKI incidence in vancomycin- piperacillin/tazobactam and vancomycin-cefepime/meropenem groups were 21.9% and 16.8%, respectively (p = 0.068). Multivariable prediction models showed concomitant vancomycin-piperacillin/tazobactam was an independent risk factor of AKI using serum creatinine only (HR 1.52, 1.10-2.10, p = 0.011) and serum creatinine with urine output-based KDIGO criteria (HR 1.77, 1.18-2.67, p = 0.006). No significant differences between groups were observed for AKI recovery patterns or mortality. CONCLUSION: Concomitant vancomycin and piperacillin/tazobactam administration in adult ICU patients was independently associated with an increased risk of AKI.
PURPOSE: The risk of acute kidney injury (AKI) associated with concomitant vancomycin and piperacillin/tazobactam in the intensive care unit (ICU) remains controversial. The aim of this study was to compare the AKI incidence associated with concomitant vancomycin and piperacillin/tazobactam compared to either cefepime or meropenem with vancomycin in the ICU. MATERIALS AND METHODS: A multicenter, retrospective, propensity score-matched cohort study was conducted in adult ICU patients administered vancomycin in combination with either piperacillin/tazobactam, cefepime, or meropenem were included. Patients developing AKI ≤48 h following combination therapy initiation were excluded. The primary endpoint was to compare the incidence of AKI associated with concomitant antimicrobial therapy. Multivariable Cox regression modeling in predicting AKI was also conducted. RESULTS: A total of 1044 patients were matched. The AKI incidence in vancomycin- piperacillin/tazobactam and vancomycin-cefepime/meropenem groups were 21.9% and 16.8%, respectively (p = 0.068). Multivariable prediction models showed concomitant vancomycin-piperacillin/tazobactam was an independent risk factor of AKI using serum creatinine only (HR 1.52, 1.10-2.10, p = 0.011) and serum creatinine with urine output-based KDIGO criteria (HR 1.77, 1.18-2.67, p = 0.006). No significant differences between groups were observed for AKI recovery patterns or mortality. CONCLUSION: Concomitant vancomycin and piperacillin/tazobactam administration in adult ICU patients was independently associated with an increased risk of AKI.
Authors: Nuala J Meyer; Michael G S Shashaty; Todd A Miano; Sean Hennessy; Wei Yang; Thomas G Dunn; Ariel R Weisman; Oluwatosin Oniyide; Roseline S Agyekum; Alexandra P Turner; Caroline A G Ittner; Brian J Anderson; F Perry Wilson; Raymond Townsend; John P Reilly; Heather M Giannini; Christopher V Cosgriff; Tiffanie K Jones Journal: Intensive Care Med Date: 2022-07-14 Impact factor: 41.787