Vancomycin plus piperacillin/tazobactam ups risk of acute kidney injury

Concomitant administration of vancomycin (VAN) and piperacillin/tazobactam (PTZ) appears to contribute to a heightened risk of acute kidney injury (AKI) in adult patients in the general ward, results of a study have shown. In addition, VAN+PTZ is associated with more severe AKI.

Noncritically ill adult patients were enrolled in this multicentre, retrospective, propensity score cohort study. Those who received VAN-PTZ or VAN plus either cefepime (CEF) or meropenem (MER) were included in the analysis. Patients who developed AKI within 48 hours following administration of the combination therapy were excluded.

The incidence of AKI between treatment groups was the primary endpoint. The investigators also predicted AKI using multivariable Cox regression modelling.

Overall, 3,199 patients met the eligibility criteria. The incidence of AKI was substantially higher with VAN+PTZ than with VAN+CEF/MER (16.4 percent vs 8.7 percent; p<0.001). In addition, AKI onset was 1.8 days earlier with VAN+PTZ compared with VAN+CEF/MER (p<0.001).

In the multivariate prediction model, the investigators found concomitant VAN+PTZ to be independently associated with a significantly increased risk of developing AKI (hazard ratio, 2.34, 95 percent confidence interval, 1.82‒3.01; p<0.001).

Patients in the VAN+PTZ group were also more likely to experience severe AKI (stage II or III) than those in the VAN+CEF/MER group (p=0.002). However, there were no differences seen in the AKI recovery patterns of patients in both treatment groups.