Format

Send to

Choose Destination
Antimicrob Agents Chemother. 2019 Apr 25;63(5). pii: e02658-18. doi: 10.1128/AAC.02658-18. Print 2019 May.

Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin-Tazobactam, Cefepime, or Meropenem.

Author information

1
Department of Pharmacy, The University of Kansas Health System, Kansas City, Kansas, USA.
2
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
3
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
4
Department of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, Missouri, USA.
5
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA Paul.Juang@stlcop.edu.

Abstract

Critically ill patients are frequently treated with empirical antibiotic therapy, including vancomycin and β-lactams. Recent evidence suggests an increased risk of acute kidney injury (AKI) in patients who received a combination of vancomycin and piperacillin-tazobactam (VPT) compared with patients who received vancomycin alone or vancomycin in combination with cefepime (VC) or meropenem (VM), but most studies were conducted predominately in the non-critically ill population. A retrospective cohort study that included 2,492 patients was conducted in the intensive care units of a large university hospital with the primary outcome being the development of any AKI. The rates of any AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, were 39.3% for VPT patients, 24.2% for VC patients, and 23.5% for VM patients (P < 0.0001 for both comparisons). Similarly, the incidences of stage 2 and stage 3 AKI were also significantly higher for VPT patients than for the patients in the other groups. The rates of stage 2 and stage 3 AKI, respectively, were 15% and 6.6% for VPT patients, 5.8% and 1.8% for VC patients, and 6.6% and 1.3% for VM patients (P < 0.0001 for both comparisons). In multivariate analysis, the use of vancomycin in combination with piperacillin-tazobactam was found to be an independent predictor of AKI (odds ratio [OR], 2.161; 95% confidence interval [CI], 1.620 to 2.883). In conclusion, critically ill patients receiving the combination of VPT had the highest incidence of AKI compared to critically ill patients receiving either VC or VM.

KEYWORDS:

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

PMID:
30782987
PMCID:
PMC6496064
[Available on 2019-10-25]
DOI:
10.1128/AAC.02658-18

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center