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Pharmacotherapy. 2014 Jul;34(7):662-9. doi: 10.1002/phar.1428. Epub 2014 Apr 18.

Comparison of acute kidney injury during treatment with vancomycin in combination with piperacillin-tazobactam or cefepime.

Author information

1
UF Health Jacksonville, Jacksonville, Florida.

Abstract

STUDY OBJECTIVE:

To evaluate the observed incidence of acute kidney injury (AKI) in adult patients receiving either piperacillin-tazobactam and vancomycin or cefepime-vancomycin for more than 48 hours.

DESIGN:

Retrospective matched cohort.

SETTING:

Large academic medical center.

PATIENTS:

Adult patients without preexisting renal dysfunction admitted over an 8-month time period who received either the combination of piperacillin-tazobactam and vancomycin or cefepime-vancomycin for more than 48 hours were evaluated for AKI, defined by the Acute Kidney Injury Network criteria.

MEASUREMENTS AND MAIN RESULTS:

A total of 224 patients receiving either antimicrobial combination were evaluated for AKI. The incidence of AKI was significantly higher in the piperacillin-tazobactam and vancomycin group (34.8%) compared with the cefepime-vancomycin group (12.5%) in the unmatched analysis (p<0.0001). After adjusting for potential sources of bias through propensity score matched pairs and conditional logistic regression, piperacillin-tazobactam and vancomycin combination therapy (p=0.003) was an independent predictor of AKI. There were no significant differences in time to AKI or hospital length of stay between groups.

CONCLUSIONS:

The results of this study suggest that there may be an association between piperacillin-tazobactam and vancomycin combination therapy and increased incidence of AKI.

KEYWORDS:

acute kidney injury; cefepime; nephrotoxicity; piperacillin-tazobactam; vancomycin

PMID:
24753221
DOI:
10.1002/phar.1428
[Indexed for MEDLINE]

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