Vancomycin with concomitant piperacillin/tazobactam vs. cefepime or meropenem associated acute kidney injury in the critically ill: A multicenter propensity score-matched study
The risk of acute kidney injury (AKI) associated with concomitant vancomycin and piperacillin/tazobactam in the intensive care unit (ICU) remains controversial. The aim of this study was to compare the AKI incidence associated with concomitant vancomycin and piperacillin/tazobactam compared to eithe...
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| Veröffentlicht in: | Journal of critical care 2022-02, Vol.67, p.134-140 |
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| creator | Buckley, Mitchell S. Komerdelj, Ivan A. D'Alessio, Paul A. Rangan, Pooja Agarwal, Sumit K. Tinta, Nicole C. Martinez, Brandon K. Ziadat, Delia S. Yerondopoulos, Melanie J. Kobic, Emir Kane-Gill, Sandra L. |
| description | The risk of acute kidney injury (AKI) associated with concomitant vancomycin and piperacillin/tazobactam in the intensive care unit (ICU) remains controversial. The aim of this study was to compare the AKI incidence associated with concomitant vancomycin and piperacillin/tazobactam compared to either cefepime or meropenem with vancomycin in the ICU.
A multicenter, retrospective, propensity score-matched cohort study was conducted in adult ICU patients administered vancomycin in combination with either piperacillin/tazobactam, cefepime, or meropenem were included. Patients developing AKI ≤48 h following combination therapy initiation were excluded. The primary endpoint was to compare the incidence of AKI associated with concomitant antimicrobial therapy. Multivariable Cox regression modeling in predicting AKI was also conducted.
A total of 1044 patients were matched. The AKI incidence in vancomycin- piperacillin/tazobactam and vancomycin-cefepime/meropenem groups were 21.9% and 16.8%, respectively (p = 0.068). Multivariable prediction models showed concomitant vancomycin-piperacillin/tazobactam was an independent risk factor of AKI using serum creatinine only (HR 1.52, 1.10–2.10, p = 0.011) and serum creatinine with urine output-based KDIGO criteria (HR 1.77, 1.18–2.67, p = 0.006). No significant differences between groups were observed for AKI recovery patterns or mortality.
Concomitant vancomycin and piperacillin/tazobactam administration in adult ICU patients was independently associated with an increased risk of AKI.
•Concomitant vancomycin and piperacillin/tazobactam was an independent risk factor of developing AKI in ICU patients.•Final prediction models corroborated these findings using serum creatinine with or without urine output-based AKI criteria.•Majority of AKI observed was considered mild (Stage I KDIGO) and resolved |
| doi_str_mv | 10.1016/j.jcrc.2021.10.018 |
| format | Article |
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A multicenter, retrospective, propensity score-matched cohort study was conducted in adult ICU patients administered vancomycin in combination with either piperacillin/tazobactam, cefepime, or meropenem were included. Patients developing AKI ≤48 h following combination therapy initiation were excluded. The primary endpoint was to compare the incidence of AKI associated with concomitant antimicrobial therapy. Multivariable Cox regression modeling in predicting AKI was also conducted.
A total of 1044 patients were matched. The AKI incidence in vancomycin- piperacillin/tazobactam and vancomycin-cefepime/meropenem groups were 21.9% and 16.8%, respectively (p = 0.068). Multivariable prediction models showed concomitant vancomycin-piperacillin/tazobactam was an independent risk factor of AKI using serum creatinine only (HR 1.52, 1.10–2.10, p = 0.011) and serum creatinine with urine output-based KDIGO criteria (HR 1.77, 1.18–2.67, p = 0.006). No significant differences between groups were observed for AKI recovery patterns or mortality.
Concomitant vancomycin and piperacillin/tazobactam administration in adult ICU patients was independently associated with an increased risk of AKI.
•Concomitant vancomycin and piperacillin/tazobactam was an independent risk factor of developing AKI in ICU patients.•Final prediction models corroborated these findings using serum creatinine with or without urine output-based AKI criteria.•Majority of AKI observed was considered mild (Stage I KDIGO) and resolved <3 days.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2021.10.018</identifier><identifier>PMID: 34768175</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute kidney injury ; Acute Kidney Injury - chemically induced ; Acute Kidney Injury - epidemiology ; Acute Kidney Injury - therapy ; Adult ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; beta-lactam ; Cefepime - adverse effects ; Cohort Studies ; Creatinine ; Critical care ; Critical Illness ; Drug dosages ; Drug Therapy, Combination ; Hospitals ; Humans ; Kidney diseases ; Length of stay ; Meropenem - adverse effects ; Mortality ; Nephrotoxicity ; Patients ; Penicillanic Acid - adverse effects ; Piperacillin - adverse effects ; Piperacillin, Tazobactam Drug Combination - adverse effects ; Piperacillin/tazobactam ; Propensity Score ; Recovery (Medical) ; Renal replacement therapy ; Retrospective Studies ; Sepsis ; Staphylococcus infections ; Vancomycin - adverse effects ; Vancomycin, critical care, intensive care unit</subject><ispartof>Journal of critical care, 2022-02, Vol.67, p.134-140</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><rights>2021. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-acb2dee336e66db53c4c49beb6d1d16f84c265418c2d2c73ff8e9ae8037b4b4a3</citedby><cites>FETCH-LOGICAL-c384t-acb2dee336e66db53c4c49beb6d1d16f84c265418c2d2c73ff8e9ae8037b4b4a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0883944121002410$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34768175$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Buckley, Mitchell S.</creatorcontrib><creatorcontrib>Komerdelj, Ivan A.</creatorcontrib><creatorcontrib>D'Alessio, Paul A.</creatorcontrib><creatorcontrib>Rangan, Pooja</creatorcontrib><creatorcontrib>Agarwal, Sumit K.</creatorcontrib><creatorcontrib>Tinta, Nicole C.</creatorcontrib><creatorcontrib>Martinez, Brandon K.</creatorcontrib><creatorcontrib>Ziadat, Delia S.</creatorcontrib><creatorcontrib>Yerondopoulos, Melanie J.</creatorcontrib><creatorcontrib>Kobic, Emir</creatorcontrib><creatorcontrib>Kane-Gill, Sandra L.</creatorcontrib><title>Vancomycin with concomitant piperacillin/tazobactam vs. cefepime or meropenem associated acute kidney injury in the critically ill: A multicenter propensity score-matched study</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>The risk of acute kidney injury (AKI) associated with concomitant vancomycin and piperacillin/tazobactam in the intensive care unit (ICU) remains controversial. The aim of this study was to compare the AKI incidence associated with concomitant vancomycin and piperacillin/tazobactam compared to either cefepime or meropenem with vancomycin in the ICU.
A multicenter, retrospective, propensity score-matched cohort study was conducted in adult ICU patients administered vancomycin in combination with either piperacillin/tazobactam, cefepime, or meropenem were included. Patients developing AKI ≤48 h following combination therapy initiation were excluded. The primary endpoint was to compare the incidence of AKI associated with concomitant antimicrobial therapy. Multivariable Cox regression modeling in predicting AKI was also conducted.
A total of 1044 patients were matched. The AKI incidence in vancomycin- piperacillin/tazobactam and vancomycin-cefepime/meropenem groups were 21.9% and 16.8%, respectively (p = 0.068). Multivariable prediction models showed concomitant vancomycin-piperacillin/tazobactam was an independent risk factor of AKI using serum creatinine only (HR 1.52, 1.10–2.10, p = 0.011) and serum creatinine with urine output-based KDIGO criteria (HR 1.77, 1.18–2.67, p = 0.006). No significant differences between groups were observed for AKI recovery patterns or mortality.
Concomitant vancomycin and piperacillin/tazobactam administration in adult ICU patients was independently associated with an increased risk of AKI.
•Concomitant vancomycin and piperacillin/tazobactam was an independent risk factor of developing AKI in ICU patients.•Final prediction models corroborated these findings using serum creatinine with or without urine output-based AKI criteria.•Majority of AKI observed was considered mild (Stage I KDIGO) and resolved <3 days.</description><subject>Acute kidney injury</subject><subject>Acute Kidney Injury - chemically induced</subject><subject>Acute Kidney Injury - epidemiology</subject><subject>Acute Kidney Injury - therapy</subject><subject>Adult</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>beta-lactam</subject><subject>Cefepime - adverse effects</subject><subject>Cohort Studies</subject><subject>Creatinine</subject><subject>Critical care</subject><subject>Critical Illness</subject><subject>Drug dosages</subject><subject>Drug Therapy, Combination</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Kidney diseases</subject><subject>Length of stay</subject><subject>Meropenem - adverse effects</subject><subject>Mortality</subject><subject>Nephrotoxicity</subject><subject>Patients</subject><subject>Penicillanic Acid - adverse effects</subject><subject>Piperacillin - adverse effects</subject><subject>Piperacillin, Tazobactam Drug Combination - adverse effects</subject><subject>Piperacillin/tazobactam</subject><subject>Propensity Score</subject><subject>Recovery (Medical)</subject><subject>Renal replacement therapy</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Staphylococcus infections</subject><subject>Vancomycin - adverse effects</subject><subject>Vancomycin, critical care, intensive care unit</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kctu1TAQhiMEoqXwAiyQJTZschrHl_ggNlXFTarEBthaznii45DYwXZaHZ6KR8ThFBYsWI3865tPI_9V9Zw2O9pQeTnuRoiwa5uWlmDXUPWgOqdCdLWSVDyszhulWL3nnJ5VT1Iam4Z2jInH1RnjnVS0E-fVz6_GQ5iP4Dy5c_lAIGxvl43PZHELRgNumpy_zOZH6A1kM5PbtCOAAy5uRhIimTGGBT3OxKQUwJmMlhhYM5Jvzno8EufHNW6D5AMSiC47MNNUkml6Ta7IvE4lQZ8xkuW3LLl8JAlCxHo2GQ7FmPJqj0-rR4OZEj67nxfVl3dvP19_qG8-vf94fXVTA1M81wb61iIyJlFK2wsGHPi-x15aaqkcFIdWCk4VtLaFjg2Dwr1B1bCu5z037KJ6dfKWc76vmLKeXQKcJuMxrEm3Yt9xJbhiBX35DzqGNfpynW5lozgXeykK1Z4oiCGliINeoptNPGra6K1PPeqtT731uWWlz7L04l699jPavyt_CizAmxOA5S9uHUadwKEHtC4iZG2D-5__FypAtr0</recordid><startdate>202202</startdate><enddate>202202</enddate><creator>Buckley, Mitchell S.</creator><creator>Komerdelj, Ivan A.</creator><creator>D'Alessio, Paul A.</creator><creator>Rangan, Pooja</creator><creator>Agarwal, Sumit K.</creator><creator>Tinta, Nicole C.</creator><creator>Martinez, Brandon K.</creator><creator>Ziadat, Delia S.</creator><creator>Yerondopoulos, Melanie J.</creator><creator>Kobic, Emir</creator><creator>Kane-Gill, Sandra L.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202202</creationdate><title>Vancomycin with concomitant piperacillin/tazobactam vs. cefepime or meropenem associated acute kidney injury in the critically ill: A multicenter propensity score-matched study</title><author>Buckley, Mitchell S. ; Komerdelj, Ivan A. ; D'Alessio, Paul A. ; Rangan, Pooja ; Agarwal, Sumit K. ; Tinta, Nicole C. ; Martinez, Brandon K. ; Ziadat, Delia S. ; Yerondopoulos, Melanie J. ; Kobic, Emir ; Kane-Gill, Sandra L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-acb2dee336e66db53c4c49beb6d1d16f84c265418c2d2c73ff8e9ae8037b4b4a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Acute kidney injury</topic><topic>Acute Kidney Injury - chemically induced</topic><topic>Acute Kidney Injury - epidemiology</topic><topic>Acute Kidney Injury - therapy</topic><topic>Adult</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>beta-lactam</topic><topic>Cefepime - adverse effects</topic><topic>Cohort Studies</topic><topic>Creatinine</topic><topic>Critical care</topic><topic>Critical Illness</topic><topic>Drug dosages</topic><topic>Drug Therapy, Combination</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Kidney diseases</topic><topic>Length of stay</topic><topic>Meropenem - adverse effects</topic><topic>Mortality</topic><topic>Nephrotoxicity</topic><topic>Patients</topic><topic>Penicillanic Acid - adverse effects</topic><topic>Piperacillin - adverse effects</topic><topic>Piperacillin, Tazobactam Drug Combination - adverse effects</topic><topic>Piperacillin/tazobactam</topic><topic>Propensity Score</topic><topic>Recovery (Medical)</topic><topic>Renal replacement therapy</topic><topic>Retrospective Studies</topic><topic>Sepsis</topic><topic>Staphylococcus infections</topic><topic>Vancomycin - adverse effects</topic><topic>Vancomycin, critical care, intensive care unit</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Buckley, Mitchell S.</creatorcontrib><creatorcontrib>Komerdelj, Ivan A.</creatorcontrib><creatorcontrib>D'Alessio, Paul A.</creatorcontrib><creatorcontrib>Rangan, Pooja</creatorcontrib><creatorcontrib>Agarwal, Sumit K.</creatorcontrib><creatorcontrib>Tinta, Nicole C.</creatorcontrib><creatorcontrib>Martinez, Brandon K.</creatorcontrib><creatorcontrib>Ziadat, Delia S.</creatorcontrib><creatorcontrib>Yerondopoulos, Melanie J.</creatorcontrib><creatorcontrib>Kobic, Emir</creatorcontrib><creatorcontrib>Kane-Gill, Sandra L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Buckley, Mitchell S.</au><au>Komerdelj, Ivan A.</au><au>D'Alessio, Paul A.</au><au>Rangan, Pooja</au><au>Agarwal, Sumit K.</au><au>Tinta, Nicole C.</au><au>Martinez, Brandon K.</au><au>Ziadat, Delia S.</au><au>Yerondopoulos, Melanie J.</au><au>Kobic, Emir</au><au>Kane-Gill, Sandra L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vancomycin with concomitant piperacillin/tazobactam vs. cefepime or meropenem associated acute kidney injury in the critically ill: A multicenter propensity score-matched study</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2022-02</date><risdate>2022</risdate><volume>67</volume><spage>134</spage><epage>140</epage><pages>134-140</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>The risk of acute kidney injury (AKI) associated with concomitant vancomycin and piperacillin/tazobactam in the intensive care unit (ICU) remains controversial. The aim of this study was to compare the AKI incidence associated with concomitant vancomycin and piperacillin/tazobactam compared to either cefepime or meropenem with vancomycin in the ICU.
A multicenter, retrospective, propensity score-matched cohort study was conducted in adult ICU patients administered vancomycin in combination with either piperacillin/tazobactam, cefepime, or meropenem were included. Patients developing AKI ≤48 h following combination therapy initiation were excluded. The primary endpoint was to compare the incidence of AKI associated with concomitant antimicrobial therapy. Multivariable Cox regression modeling in predicting AKI was also conducted.
A total of 1044 patients were matched. The AKI incidence in vancomycin- piperacillin/tazobactam and vancomycin-cefepime/meropenem groups were 21.9% and 16.8%, respectively (p = 0.068). Multivariable prediction models showed concomitant vancomycin-piperacillin/tazobactam was an independent risk factor of AKI using serum creatinine only (HR 1.52, 1.10–2.10, p = 0.011) and serum creatinine with urine output-based KDIGO criteria (HR 1.77, 1.18–2.67, p = 0.006). No significant differences between groups were observed for AKI recovery patterns or mortality.
Concomitant vancomycin and piperacillin/tazobactam administration in adult ICU patients was independently associated with an increased risk of AKI.
•Concomitant vancomycin and piperacillin/tazobactam was an independent risk factor of developing AKI in ICU patients.•Final prediction models corroborated these findings using serum creatinine with or without urine output-based AKI criteria.•Majority of AKI observed was considered mild (Stage I KDIGO) and resolved <3 days.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34768175</pmid><doi>10.1016/j.jcrc.2021.10.018</doi><tpages>7</tpages></addata></record> |
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| ispartof | Journal of critical care, 2022-02, Vol.67, p.134-140 |
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| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Acute kidney injury Acute Kidney Injury - chemically induced Acute Kidney Injury - epidemiology Acute Kidney Injury - therapy Adult Anti-Bacterial Agents - therapeutic use Antibiotics beta-lactam Cefepime - adverse effects Cohort Studies Creatinine Critical care Critical Illness Drug dosages Drug Therapy, Combination Hospitals Humans Kidney diseases Length of stay Meropenem - adverse effects Mortality Nephrotoxicity Patients Penicillanic Acid - adverse effects Piperacillin - adverse effects Piperacillin, Tazobactam Drug Combination - adverse effects Piperacillin/tazobactam Propensity Score Recovery (Medical) Renal replacement therapy Retrospective Studies Sepsis Staphylococcus infections Vancomycin - adverse effects Vancomycin, critical care, intensive care unit |
| title | Vancomycin with concomitant piperacillin/tazobactam vs. cefepime or meropenem associated acute kidney injury in the critically ill: A multicenter propensity score-matched study |
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