Should We Revisit the Nephrotoxic Potential of Piperacillin-Tazobactam as Well?

To the Editor—Navalkele et al should be commended for their study of the comparative risk of acute kidney injury (AKI) in patients who receive vancomycin combined with either piperacillin–tazobactam (VPT) or cefepime [1]. The authors' findings of significantly higher risk of AKI in the VPT group supports much of the existing literature in implicating VPT as a potentially nephrotoxic drug combination [2]. Although the exact mechanism underlying VPT-associated nephrotoxicity remains unclear, an additive nephrotoxic effect of vancomycin (eg, acute tubular necrosis) and that of piperacillin (eg, acute interstitial nephritis [AIN]) is often posited [2, 3].

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