Association of piperacillin and vancomycin exposure on acute kidney injury during combination therapy.
JAC Antimicrob Resist
; 6(1): dlad157, 2024 Feb.
Article
in En
| MEDLINE
| ID: mdl-38259903
ABSTRACT
Objectives:
Acute kidney injury (AKI) is a well-documented adverse effect observed with piperacillin/tazobactam in combination with vancomycin. The pharmacokinetics of these antibiotics when given in combination have not been previously evaluated. The purpose of this study was to compare the exposure of vancomycinâ+âpiperacillin/tazobactam in patients with and without AKI.Methods:
Ninety adult patients, who received at least 72â h of vancomycinâ+âpiperacillin/tazobactam combination therapy and had available serum concentrations of vancomycin and piperacillin were included in the study. Nephrotoxicity was defined as a 1.5-fold increase in serum creatinine within 7â days from baseline. Median daily AUCs were calculated in those with nephrotoxicity (vancomycinâ+âpiperacillin/tazobactam 'N') versus those without nephrotoxicity (vancomycinâ+âpiperacillin/tazobactam 'WN') during the first 7â days of combination therapy.Results:
The overall incidence of AKI in those receiving vancomycinâ+âpiperacillin/tazobactam was 20% (18/90). The median daily vancomycin AUCs did not differ between the vancomycinâ+âpiperacillin/tazobactam 'WN' and vancomycinâ+âpiperacillin/tazobactam 'N' groups. Although not statistically significant, the median daily vancomycin AUCs in the vancomycinâ+âpiperacillin/tazobactam 'N' group were numerically greater on Day 5 and trended downwards thereafter. For the piperacillin group, the median daily AUCs did not vary between groups, except on Day 7 where the vancomycinâ+âpiperacillin/tazobactam 'WN' group had statistically greater median piperacillin AUC than the vancomycinâ+âpiperacillin/tazobactam 'N' group (Pâ=â0.046).Conclusions:
Utilizing serum creatinine-defined AKI, our study did not find any significant differences in vancomycin and piperacillin/tazobactam exposure between the groups with and without nephrotoxicity. These data indicate that vancomycinâ+âpiperacillin/tazobactam should not be avoided due to the risk of overexposure; instead, clinicians should continue to use these therapies cautiously.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Risk_factors_studies
Language:
En
Journal:
JAC Antimicrob Resist
Year:
2024
Document type:
Article
Affiliation country: