Comparison of acute kidney injury risk associated with vancomycin and concomitant piperacillin/tazobactam or cefepime in the intensive care unit

J Crit Care. 2018 Dec:48:32-38. doi: 10.1016/j.jcrc.2018.08.007. Epub 2018 Aug 11.


Purpose: The objective of this study was to evaluate AKI incidence with concomitant vancomycin and piperacillin/tazobactam (PTZ) compared to vancomycin and cefepime (FEP) in critically ill patients.

Materials and methods: A retrospective, cohort study was conducted in adult critically ill patients from January 1, 2014 to December 31, 2017. The primary aim was to compare the incidence of AKI during concomitant therapy or until hospital discharge. Secondary analyses included AKI severity, time to AKI as well as recovery, and clinical outcomes.

Results: Overall, 333 patients were evaluated. The AKI rate in the vancomycin/PTZ group and vancomycin/FEP group were similar (19.5% vs. 17.3%, respectively, p = .612). Renal replacement therapy (RRT) was initiated in 10.0% and 3.8% administered vancomycin/PTZ and vancomycin/FEP groups, respectively (p = .04). Multivariate regression found vancomycin/PTZ was not associated with an increased risk of developing AKI although the presence of shock was identified as an independent risk factor (odds ratio, 3.22; 95% CI, 1.66-6.26). No significant differences in hospital or ICU length of stay or in-hospital mortality were observed between study groups.

Conclusions: Concomitant PTZ and vancomycin in ICU patients was not associated with an increased risk of developing AKI compared to FEP and vancomycin combinations. More patients administered vancomycin/PTZ received RRT.

Keywords: Acute kidney injury; Cefepime; Critical care; Intensive care unit; Nephrotoxicity; Piperacillin tazobactam; Vancomycin.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / therapy
  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects*
  • Cefepime / administration & dosage
  • Cefepime / adverse effects*
  • Critical Illness
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Piperacillin, Tazobactam Drug Combination / administration & dosage
  • Piperacillin, Tazobactam Drug Combination / adverse effects*
  • Retrospective Studies
  • Sepsis / drug therapy*


  • Anti-Bacterial Agents
  • Piperacillin, Tazobactam Drug Combination
  • Cefepime