Prospective Comparison of Acute Kidney Injury During Treatment With the Combination of Piperacillin-Tazobactam and Vancomycin Versus the Combination of Cefepime or Meropenem and Vancomycin

J Pharm Pract. 2017 Apr;30(2):209-213. doi: 10.1177/0897190016628960. Epub 2016 Jul 9.

Abstract

Purpose: To prospectively evaluate the observed incidence of acute kidney injury (AKI) in adult patients receiving the combination of piperacillin-tazobactam and vancomycin versus the combination of cefepime or meropenem and vancomycin for greater than 72 hours.

Methods: This was a prospective, open-label cohort study at a community academic medical center involving adult patients over a 3-month time period who received either the combination of piperacillin-tazobactam and vancomycin or the combination of cefepime or meropenem and vancomycin for greater than 72 hours. The patients were evaluated for AKI, defined using specific criteria introduced by Kidney Disease: Improving global outcomes (KDIGO) acute kidney injury work group in 2012.

Results: A total of 85 patients receiving either antimicrobial combination were evaluated for AKI. The incidence of AKI was significantly higher in the piperacillin-tazobactam and vancomycin group (37.3%) compared with the cefepime or meropenem and vancomycin group (7.7%; χ2 = 7.80, P = .005).

Conclusion: The result of this study suggests that the risk of developing AKI is increased in patients receiving the combination of piperacillin-tazobactam and vancomycin versus those receiving the combination of cefepime or meropenem and vancomycin.

Keywords: critical care; infectious disease; internal medicine; medication safety; nephrology.

Publication types

  • Comparative Study

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / drug therapy*
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects
  • Cefepime
  • Cephalosporins / administration & dosage
  • Cephalosporins / adverse effects*
  • Cohort Studies
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Meropenem
  • Middle Aged
  • Penicillanic Acid / administration & dosage
  • Penicillanic Acid / adverse effects
  • Penicillanic Acid / analogs & derivatives*
  • Piperacillin / administration & dosage
  • Piperacillin / adverse effects
  • Piperacillin, Tazobactam Drug Combination
  • Prospective Studies
  • Thienamycins / administration & dosage
  • Thienamycins / adverse effects*
  • Treatment Outcome
  • Vancomycin / administration & dosage
  • Vancomycin / adverse effects*

Substances

  • Anti-Bacterial Agents
  • Cephalosporins
  • Thienamycins
  • Piperacillin, Tazobactam Drug Combination
  • Vancomycin
  • Cefepime
  • Penicillanic Acid
  • Meropenem
  • Piperacillin