Comparative Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin‐Tazobactam or Cefepime: A Retrospective Cohort Study

Hammond, Drayton A.; Smith, Melanie; Painter, Jacob T.; Meena, Nikhil; Lusardi, Katherine

doi:10.1002/phar.1738

Cited by 93 publications

(107 citation statements)

References 49 publications

(185 reference statements)

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“…To our knowledge, this is the largest study to date to examine the difference in AKI incidence among patients treated with VAN and FEP or PTZ. We found the AKI rate in patients treated with VAN-TZP to be 21.4%, whereas the range of the incidence found in the current literature is 9.5 to 34.8% (8)(9)(10)(11)(12)(13)(14)(15)(16). The AKI incidence in the VAN-FEP group was similar to previous reports of 12.5% (9,10).…”

Section: Discussionsupporting

confidence: 54%

“…In addition, aside from the study of Gomes et al (10), confounding was not adequately addressed in the studies, further limiting their application. Our study attempted to rectify these issues by including a larger number of patients (4,193 in the present study versus 485 in the previous studies combined) (9)(10)(11) and utilizing a propensity score matching algorithm to control for confounders. The difference in AKI incidence was maintained after controlling for confounders, suggesting that the use of TZP is associated with increasing rates of AKI compared to those achieved with the use of FEP when the drugs are combined with VAN.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, they found that TZP was an independent predictor of AKI in multiple logistic regression modeling. Finally, in a review of 122 critically ill patients, Hammond et al found no difference in AKI incidence among patients treated with VAN-TZP and VAN-FEP (32.7 versus 28.8%, P ϭ 0.647) (11).…”

Section: Discussionmentioning

confidence: 99%

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Nephrotoxicity during Vancomycin Therapy in Combination with Piperacillin-Tazobactam or Cefepime

Rutter

Cox

Martin

et al. 2017

Antimicrob Agents Chemother

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Recent reports have demonstrated that vancomycin (VAN) may lead to an increase in the incidence of acute kidney injury (AKI) when it is combined with antipseudomonal beta-lactams. This study compared the incidence of AKI associated with VAN plus piperacillin-tazobactam (TZP) or cefepime (FEP). This was a retrospective, matched cohort study that was conducted at an academic medical center between September 2010 and September 2014 and that included adult patients without severe chronic or structural kidney disease, dialysis, pregnancy, cystic fibrosis, or a hospital transfer receiving TZP-VAN or FEP-VAN for at least 48 h. The primary outcome was the difference in the AKI incidence between the TZP-VAN and FEP-VAN groups, evaluated using the risk, injury, failure, loss of kidney function, and endstage kidney disease (RIFLE) criteria. Patients in the two groups were matched on the basis of age, sex, severity of illness, baseline creatinine clearance, hypotension, number of nephrotoxicity risk factors, and intravenous contrast exposure. In total, 4,193 patients met all inclusion criteria (3,605 received TZP-VAN and 588 received FEP-VAN). The unadjusted AKI incidence was 21.4% in patients receiving TZP-VAN, whereas it was 12.6% in patients receiving FEP-VAN (P Ͻ 0.001). After the patients were matched, 1,633 patients receiving TZP-VAN and 578 patients receiving FEP-VAN were evaluated. The AKI incidence remained higher in patients receiving TZP-VAN than in those receiving FEP-VAN (21.4% versus 12.5%, P Ͻ 0.0001). This trend remained true for all classifications of the RIFLE criteria. After controlling for remaining confounders, TZP-VAN therapy was associated with 2.18 times the odds of AKI than FEP-VAN therapy (95% confidence interval, 1.64 to 2.94 times) in logistic regression. AKI was significantly more common in patients receiving vancomycin in combination with piperacillin-tazobactam than in those receiving vancomycin in combination with cefepime. This finding reinforces the need for the judicious use of combination empirical antimicrobial therapy.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Nephrotoxicity during Vancomycin Therapy in Combination with Piperacillin-Tazobactam or Cefepime

Rutter

Cox

Martin

et al. 2017

Antimicrob Agents Chemother

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“…Numerous risk factors exist for vancomycin-associated nephrotoxicity, including vancomycin trough concentrations3 ≥15 mcg/mL, concomitant exposure to other nephrotoxins, such as aminoglycosides4 and piperacillin/tazobactam5,6,7,8,9,10,11,12,13, duration of exposure,12,14-16, and total daily dose 15,17. Due diligence is necessary when vancomycin is used in patients.…”

Section: Introductionmentioning

confidence: 99%

Effects of staff education and standardizing dosing and collection times on vancomycin trough appropriateness in ward patients

Hammond¹,

Atkinson²,

James³

et al. 2017

Pharm Pract (Granada)

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Background:Many institutions have guidelines for initiation and monitoring, but not timing, of vancomycin.Objective:Our objective was to evaluate vancomycin trough collection appropriateness before and after an initiative to change the dosing and trough collection times in ward patients.Methods:A retrospective cohort study of ward patients from May 2014-16 who received scheduled intravenous vancomycin was performed. Nurse managers and pharmacists provided staff education. Differences between pre- and post-intervention groups were compared using student’s t-test for continuous data and chi-square test for categorical data.Results:Baseline characteristics were similar between the pre-intervention (n=124) and post-intervention (n=122) groups except for weight-based maintenance dose (15.3 mg/kg vs. 16.5 mg/kg, p=0.03) and percentage of troughs collected with morning labs (14% vs. 87%, p<0.001). Patients in the pre- and post-intervention groups received a similar frequency of loading doses (14.5% vs. 16%, p=0.68). There was no significant difference in percentage of vancomycin troughs collected appropriately at 30 (40% vs. 42%, p=0.72), 60 (57% vs. 63%, p=0.35), or 75 (60% vs. 68%, p=0.22) minutes from the scheduled time of the next dose.Conclusion:Staff education and standardizing collection of vancomycin troughs with morning blood collections did not affect the percentage of appropriately collected vancomycin troughs.

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“…Two adult studies showed that compared to vancomycin monotherapy, when vancomycin is used in conjunction with piperacillin/tazobactam the odds of hospitalized non-critically ill adult patients developing AKI increased by 2.48 to 5 times [54, 55], though indication bias is difficult to control for. A more recent study showed no increased risk of AKI using this drug combination in critically ill adults [56], so this risk may differ by population studied. Finally, there is even some evidence suggesting more substantial nephrotoxicity associated with piperacillin/tazobactam independent of vancomycin [2].…”

Section: What Drugs Are the Biggest Offenders?mentioning

confidence: 99%

Drug-associated acute kidney injury: who’s at risk?

et al. 2016

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The contribution of nephrotoxic medications to the development of acute kidney injury (AKI) is becoming better understood with the rise in incidence of AKI in children. Treatment of AKI is not yet available, so prevention continues to be the most effective approach. There is an opportunity to mitigate severity and prevent the occurrence of AKI if children at increased risk are identified early and nephrotoxins are used judiciously. Early detection of AKI is limited by the dependence on serum creatinine as an indicator. Promising new biomarkers may offer early detection of AKI prior to the rise in serum creatinine. Early detection of AKI is evolving and offers opportunities for better management of nephrotoxins. However, identification of patients at increased risk will remain an important first step both to focus the use of biomarker testing and to aid in its interpretation.

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Comparative Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin‐Tazobactam or Cefepime: A Retrospective Cohort Study

Cited by 93 publications

References 49 publications

Nephrotoxicity during Vancomycin Therapy in Combination with Piperacillin-Tazobactam or Cefepime

Nephrotoxicity during Vancomycin Therapy in Combination with Piperacillin-Tazobactam or Cefepime

Effects of staff education and standardizing dosing and collection times on vancomycin trough appropriateness in ward patients

Drug-associated acute kidney injury: who’s at risk?

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