Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin/Tazobactam, Cefepime, or Meropenem [Pharmacology]

Critically ill patients are frequently treated with empiric antibiotic therapy including vancomycin and β-Lactams. Recent evidence suggests an increased risk of acute kidney injury (AKI) in patients who received the 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 have been conducted predominately in the non-critically ill population. A retrospective cohort study including 2492 patients was conducted in the intensive care units of a large university hospital with the primary outcome being the development of any AKI. The rate of any AKI, as defined by the KDIGO guidelines, was 39.3% for VPT patients, 24.2% for VC, and 23.5% for VM patients (p<0.0001 for both comparisons). Similarly, the incidence of stage two and three AKI were also significantly higher for VPT patients compared to the other groups. The rate of stage two and three AKI, respectively, was 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 comparison). In multivariate analysis, the use of vancomycin in combination with piperacillin/tazobactam was found to be an independent predictor of AKI (OR 2.161 95% CI = 1.620-2.883). In conclusion, critically ill patients receiving the combination of VPT had the highest incidence of AKI when compared to critically ill patients receiving either VC and VM.

https://ift.tt/2InIZzb