Acute kidney injury more prevalent among patients on antibiotic combo vs monotherapy

Treatment with the combination of vancomycin and piperacillin/tazobactam (VAN + PTZ) appears to be associated with a greater prevalence of acute kidney injury (AKI) compared with VAN or PTZ monotherapy or with the concurrent use of VAN and cefepime (FEP) or carbapenem (CAR), a study reports.

The analysis included 752 patients from China who received VAN either as monotherapy or in combination with PTZ or CAR for at least 48 hours. Researchers conducted a Bayesian network meta-analysis to validate the resulting data and comparatively evaluate the nephrotoxic effects of β-lactam antibiotics in combination with VAN.

AKI was more prevalent in the VAN + PTZ group than in the VAN and VAN + CAR groups (15.2 percent vs 4.0 percent and 6.0 percent, respectively). Multivariable logistic regression analysis that controlled for confounding factors confirmed that VAN + PTZ was positively associated with AKI (odds ratio [OR], 4.37, 95 percent confidence interval [CI], 1.65–11.59; p=0.003).

The network meta-analysis indicated that the risk of AKI was highest with VAN + PTZ than with VAN (OR, 3.23, 95 percent CI, 2.50–4.35), PTZ (OR, 2.86, 95 percent CI, 1.92–4.12), VAN + FEP (OR, 2.37, 95 percent CI, 1.80–3.19), or VAN + CAR (OR, 2.28, 95 percent CI, 1.64–3.21). Meanwhile, there was no significant difference in AKI prevalence across the VAN, PTZ, VAN + FEP, and VAN + CAR groups.

Although providing a broad spectrum of activity against multiple pathogens, the VAN + PTZ combination has been associated with significant nephrotoxicity in some studies conducted in the US and European countries. The present data confirm this association in Asians. As such, clinicians are urged to adequately assess renal function and consider the differential risk of nephrotoxicity when choosing empiric antibiotics in hospitalized patients to minimize the incidence of AKI.