Short-course vancomycin plus piperacillin-tazobactam tied to fewer AKI incidence

Noncritically ill patients treated with a short course of vancomycin plus piperacillin-tazobactam (VPT) are less likely to experience acute kidney injury (AKI) than those who received an extended course, reports a study.

The authors conducted a retrospective cohort study to examine the AKI incidence in noncritically ill patients being treated with VPT for short courses (24 to 60 hours) compared to those receiving extended courses (72 hours to 7 days) between January 2016 and August 2018.

Fisher’s exact tests and Mann-Whitney U tests were used for differences in nominal data between groups and for continuous data, respectively.

A total of 2,567 patients were screened, of whom 154 were included in the short-course group and 106 in the extended-course group. The incidence of AKI was fewer in the short-course group than in the extended-course group (12 percent vs 26 percent; odds ratio, 2.55, 95 percent confidence interval, 1.33–4.87; p=0.004).

“Clinicians should continue to practice strict antimicrobial stewardship for VPT therapies expected to continue beyond 72 hours,” the authors said.

VPT is a common empiric combination of antimicrobials. Recent studies have reported an increase in AKI associated with combination therapy of VPT. However, most of these studies required patients to be on VPT for a minimum of 48 to 72 hours to be eligible for inclusion and had extended treatment durations longer than most short-course regimens.