title: Comparison of Rates of Nephrotoxicity Associated with Vancomycin in Combination with Piperacillin-Tazobactam Administered as an Extended versus Standard Infusion.
abstract: Despite recent reports of relatively high rates (16-37%) of acute kidney injury (AKI) in patients receiving the combination of intravenous piperacillin-tazobactam (PTZ) and vancomycin, data are limited evaluating the impact of PTZ infusion strategy on the occurrence of nephrotoxicity. The objective of this study was to compare the rates of nephrotoxicity in patients receiving vancomycin in combination with PTZ administered as an extended infusion (EI) versus a standard infusion (SI).
  
  
  
  Single-center, retrospective, matched-cohort study.
  
  
  
  Large academic tertiary care hospital.
  
  
  
  Two hundred eighty adults with a creatinine clearance (CrCl) of 40 ml/minute or higher who received at least 96 hours of vancomycin plus PTZ EI (140 patients) or vancomycin plus PTZ SI (140 patients) between January 1, 2009, and December 31, 2011, and between January 1, 2013, and December 31, 2014 (year 2012 was skipped due the closure of inpatient units following Superstorm Sandy); 48 patients in each group were admitted to the intensive care unit.
  
  
  
  The median age of all patients was 67 (interquartile range [IQR] 54-77) years, and CrCl was 75 (IQR 55-107) ml/minute. Nephrotoxicity was assessed by the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) and Acute Kidney Injury Network (AKIN) criteria. Rates of AKI, according to these criteria, were similar between groups: 17.9% versus 17.1% (p=1) and 32.9% versus 29.3% (p=0.596) for the PTZ EI and PTZ SI groups, respectively. When controlling for residual differences between groups in a conditional logistic regression analysis, no association was observed between receipt of PTZ EI and RIFLE-defined AKI (odds ratio 0.522, 95% confidence interval 0.043-6.295, p=0.609). Time to onset of nephrotoxicity was 4 (IQR 3-6) days, with no significant difference noted between groups (p=0.887).
  
  
  
  Our findings suggest a similar rate of nephrotoxicity between patients who received vancomycin in combination with PTZ EI versus PTZ SI. These results need to be further validated in a prospective randomized controlled study.
authors.affiliation: Department of Pharmacy, NYU Langone Medical Center, New York, NY.
authors.forename: Mariam
authors.initials: M
authors.lastname: Mousavi
authors.affiliation: Department of Pharmacy, NYU Langone Medical Center, New York, NY.
authors.forename: Tanya
authors.initials: T
authors.lastname: Zapolskaya
authors.affiliation: Department of Pharmacy, NYU Langone Medical Center, New York, NY.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Scipione
authors.affiliation: Division of Infectious Diseases, Department of Medicine, NYU Langone Medical Center, New York, NY.
authors.forename: Eddie
authors.initials: E
authors.lastname: Louie
authors.affiliation: Department of Pharmacy, NYU Langone Medical Center, New York, NY.
authors.forename: John
authors.initials: J
authors.lastname: Papadopoulos
authors.affiliation: Department of Pharmacy, NYU Langone Medical Center, New York, NY.
authors.forename: Yanina
authors.initials: Y
authors.lastname: Dubrovskaya
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D003404:Creatinine / Q000032:analysis; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; 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; D062606:Tertiary Care Centers; D013997:Time Factors; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D014640:Vancomycin; D010397:Penicillanic Acid; D003404:Creatinine; D010878:Piperacillin
keywords: nephrotoxicity; piperacillin-tazobactam; vancomycin