title: Comparison of acute kidney injury during treatment with vancomycin in combination with piperacillin-tazobactam or cefepime.
abstract: OBJECTIVE
  To evaluate the observed incidence of acute kidney injury (AKI) in adult patients receiving either piperacillin-tazobactam and vancomycin or cefepime-vancomycin for more than 48 hours.
  
  
  METHODS
  Retrospective matched cohort.
  
  
  METHODS
  Large academic medical center.
  
  
  METHODS
  Adult patients without preexisting renal dysfunction admitted over an 8-month time period who received either the combination of piperacillin-tazobactam and vancomycin or cefepime-vancomycin for more than 48 hours were evaluated for AKI, defined by the Acute Kidney Injury Network criteria.
  
  
  RESULTS
  A total of 224 patients receiving either antimicrobial combination were evaluated for AKI. The incidence of AKI was significantly higher in the piperacillin-tazobactam and vancomycin group (34.8%) compared with the cefepime-vancomycin group (12.5%) in the unmatched analysis (p<0.0001). After adjusting for potential sources of bias through propensity score matched pairs and conditional logistic regression, piperacillin-tazobactam and vancomycin combination therapy (p=0.003) was an independent predictor of AKI. There were no significant differences in time to AKI or hospital length of stay between groups.
  
  
  CONCLUSIONS
  The results of this study suggest that there may be an association between piperacillin-tazobactam and vancomycin combination therapy and increased incidence of AKI.
authors.affiliation: UF Health Jacksonville, Jacksonville, Florida.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Gomes
authors.forename: Carmen
authors.initials: C
authors.lastname: Smotherman
authors.forename: Amy
authors.initials: A
authors.lastname: Birch
authors.forename: Lori
authors.initials: L
authors.lastname: Dupree
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Della Vecchia
authors.forename: Dale F
authors.initials: DF
authors.lastname: Kraemer
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Jankowski
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000008:administration & dosage / Q000009:adverse effects; D000077725:Piperacillin, Tazobactam Drug Combination; D012189:Retrospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077725:Piperacillin, Tazobactam Drug Combination; D014640:Vancomycin; D000077723:Cefepime; D010397:Penicillanic Acid; D010878:Piperacillin
keywords: acute kidney injury; cefepime; nephrotoxicity; piperacillin-tazobactam; vancomycin