Vancomycin plus piperacillin/tazobactam heightens AKI risk in ICU patients

Concomitant administration of vancomycin and piperacillin/tazobactam appears to contribute to an increased risk of developing acute kidney injury in intensive care unit (ICU) patients, particularly those with normal kidney function and who require longer therapy durations, according to a retrospective study.

For the study, data from the eICU Research Institute (eRI), which holds records for ICU stays between 2010 to 2015 across 335 hospitals in the US, were used. A total of 35,654 patients who received vancomycin plus piperacillin/tazobactam (VPT group), vancomycin plus cefepime (VC group), or vancomycin plus meropenem (VM group) were included in the analysis.

The primary endpoint of AKI was defined as KDIGO stage 2 or 3 based on serum creatinine component. Propensity score matching was used to match treatment patients (VPT) with control patients (VM or VC). Sensitivity analyses were also conducted to examine the effect of longer courses of combination therapy and renal insufficiency on ICU admission.

Of the patients, 27,459 received VPT, 6,371 received VC, and 1,824 received VM. Treatment with VPT was associated with greater odds of AKI compared with both VC (odds ratio [OR], 1.37, 95 percent confidence interval [CI], 1.25–1.49) and VM (OR, 1.27, 95 percent, 1.06–1.52).

Furthermore, the VPT group was more likely to initiate dialysis than the VC group (OR, 1.28, 95 percent CI, 1.14–1.45) and the VM group (OR, 1.56, 95 percent CI, 1.23–2.00).

The odds of developing AKI were much greater among patients without renal insufficiency receiving longer duration therapy of VPT vs VM.