Abstract
CONTEXTEmpiric antibiotics are often required in hospitalized patients with serious infections who may be septic and at risk for drug resistant organisms. The purpose of this study was to evaluate the observed incidence of acute kidney injury (AKI) in a sample of adult patients receiving either piperacillin-tazobactam and vancomycin or meropenemvancomycin for at least 72 hours.METHODSSingle-center, retrospective matched cohort at a 200-bed Regional Community Medical Center. Adult patients were included in the sample if they were without preexisting renal dysfunction and admitted over an 18-month time period to receive either the combination of piperacillin-tazobactam and vancomycin or meropenem-vancomycin. Sample patients were evaluated for AKI. This condition was defined by the authors as an increase in serum creatinine of 0.5mg/ml or an increase of 50% above baseline during the duration of antibiotic treatment.RESULTSA total of 266 patients receiving either combination of antibiotics were evaluated for AKI. The incidence of AKI was significantly higher in the piperacillin-tazobactam and vancomycin group (n = 74/292, 25%) compared with the meropenem-vancomycin group (n=8/74, 9.5%, p=0.008).CONCLUSIONSThe results of this study suggest that the combination of piperacillin-tazobactam and vancomycin is associated with an increased incidence of AKI. Higher vancomycin trough concentrations were associated with increased risk for development of AKI.
Highlights
Empiric antibiotics are often required in hospitalized patients with serious infections who may be septic and at risk for drug resistant organisms.[1,2] As sepsis-associated mortality is reduced with earlier antibiotics initiation, initial broad spectrum combination antibiotic therapy is often essential.[1,3] These regimens typically include antibiotics that require coverage for both methicillin resistant Staphylococcus aureus (MRSA) and gram negative bacteria including Pseudomonas aeruginosa.[1,4] Combination therapy in these instances may often include vancomycin, which covers MRSA, and an extended-spectrum beta lactam agent such as piperacillin-tazobactam.Both of these drugs have been in use for many years
Patients in the piperacillin-tazobactam and vancomycin group were slightly older (65.3 vs. 60.3 years, p = 0.013) on average than the meropenem-vancomycin group. (Table 1) Patients in the meropenem-vancomycin group were more likely to have been in the intensive care unit (31.1% vs. 15.8%, p = 0.003) and to have received contrast dye than the piperacillin-tazobactam and vancomycin group (50% vs. 31.2%, p = 0.003)
Our study compared the incidence of acute kidney injury (AKI) between an extended beta lactam, piperacillin-tazobactam plus vancomycin with a carbapenem plus vancomycin
Summary
Empiric antibiotics are often required in hospitalized patients with serious infections who may be septic and at risk for drug resistant organisms.[1,2] As sepsis-associated mortality is reduced with earlier antibiotics initiation, initial broad spectrum combination antibiotic therapy is often essential.[1,3] These regimens typically include antibiotics that require coverage for both methicillin resistant Staphylococcus aureus (MRSA) and gram negative bacteria including Pseudomonas aeruginosa.[1,4] Combination therapy in these instances may often include vancomycin, which covers MRSA, and an extended-spectrum beta lactam agent such as piperacillin-tazobactam (brand name Zosyn).Both of these drugs have been in use for many years. Empiric antibiotics are often required in hospitalized patients with serious infections who may be septic and at risk for drug resistant organisms.[1,2] As sepsis-associated mortality is reduced with earlier antibiotics initiation, initial broad spectrum combination antibiotic therapy is often essential.[1,3] These regimens typically include antibiotics that require coverage for both methicillin resistant Staphylococcus aureus (MRSA) and gram negative bacteria including Pseudomonas aeruginosa.[1,4] Combination therapy in these instances may often include vancomycin, which covers MRSA, and an extended-spectrum beta lactam agent such as piperacillin-tazobactam (brand name Zosyn). It has been recognized that vancomycin, which covers MRSA, can cause nephrotoxicity.[2] Piperacillin-tazobactam is a beta lactam antibiotic and member of the penicillin family of antibiotics It is a broad-spectrum antibiotic with a scope of activity that covers gram-positive organisms, gram-negative organisms and anaerobes, but does not cover MRSA.[5] Gram-positive organisms include staphylococcus and streptococcus species of bacteria, while Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa predominate among gram-negative isolates.[6]
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