Dallas, TX—Do some commonly prescribed empiric antibiotics on ICU admission present a greater risk for acute kidney injury (AKI)?

That was the question raised by a new study that pointed out “evidence regarding acute kidney injury associated with concomitant administration of vancomycin and piperacillin-tazobactam is conflicting, particularly in patients in the ICU.”

The study team led by researchers from the University of Texas Southwestern Medical School focused on the commonly prescribed ICU antibiotic combinations vancomycin and piperacillin-tazobactam, vancomycin and cefepime, and vancomycin and meropenem.

The retrospective cohort study, published in CHEST, used data from the eICU Research Institute, which contains records for ICU stays between 2010 and 2015 across 335 hospitals. The researchers enrolled patients if they received vancomycin and piperacillin-tazobactam, vancomycin and cefepime, or vancomycin and meropenem exclusively. Excluded were patients with a hospital stay duration of less than 1 hour, receiving dialysis, or with missing data.

For purposes of the study, AKI was defined as Kidney Disease: Improving Global Outcomes stage II or III based on the serum creatinine component.

Ultimately, 35,654 patients met the inclusion criteria; of those 27,459 received vancomycin and piperacillin-tazobactam, 6,371 received vancomycin and cefepime, and 1,824 received vancomycin and meropenem.

The results indicated that the combination of vancomycin and piperacillin-tazobactam was associated with a higher risk of AKI and initiation of dialysis when compared with that of both vancomycin and cefepime (AKI odds ratio [OR], 1.37; 95% CI, 1.25-1.49; dialysis OR, 1.28; 95% CI, 1.14-1.45) and vancomycin and meropenem (AKI OR, 1.27; 95% CI, 1.06-1.52; dialysis OR, 1.56; 95% CI, 1.23-2.00).

“The odds of acute kidney injury developing was especially pronounced in patients without renal insufficiency receiving a longer duration of vancomycin and piperacillin-tazobactam therapy compared with vancomycin and meropenem therapy,” the researchers reported.

The study team explained that, based on its findings, “VPT [vancomycin and piperacillin-tazobactam] is associated with a higher risk of acute kidney injury than both vancomycin and cefepime and vancomycin and meropenem in patients in the ICU, especially for patients with normal initial kidney function requiring longer durations of therapy. Clinicians should consider vancomycin and meropenem or vancomycin and cefepime to reduce the risk of nephrotoxicity for patients in the ICU.”

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