Nephrotoxicity Comparison of Two Commercially Available Generic Vancomycin Products

Abstract

e To date, no comparative clinical studies have investigated the effects of different vancomycin products on nephrotoxicity. The objective of this single-center, retrospective, matched-cohort study was to investigate the impact of two different vancomycin products on the development of nephrotoxicity. The study population included adults receiving a single vancomycin product, from either Pfizer or Hospira, for their entire course of therapy. Patients were matched based on underlying nephrotoxicity risk factors. Secondary outcomes included the need for renal replacement therapy, length of hospital stay, and in-hospital mortality. One-hundred forty-six matched pairs (n ‫؍‬ 292) were included, and they had no significant differences in demographics, comorbid conditions, severity of illness, or vancomycin-associated nephrotoxicity risk factors. The frequency of nephrotoxicity was 8.9% in the Pfizer group and 11.0% in the Hospira group as defined by the 2009 consensus vancomycin guidelines (P ‫؍‬ 0.56), 17.1% in the Pfizer group and 13.0% in the Hospira group as defined by the Acute Kidney Injury Network (AKIN) (P ‫؍‬ 0.33), and 10.3% in the Pfizer group and 11.6% in the Hospira group as defined by RIFLE (risk, injury, failure, loss, and end-stage renal disease) criteria (P ‫؍‬ 0.71). There were no differences between groups in regard to nephrotoxicity by any definition or in secondary outcomes. In multivariate analysis of overall nephrotoxicity risk factors, the type of vancomycin product was not independently associated with increased odds of developing nephrotoxicity according to the RIFLE criteria. Based on our results, there are no discernible differences between Pfizer and Hospira vancomycin products in the frequency of nephrotoxicity. Confirmation of these results with other types of vancomycin and different patient populations is warranted.

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

“…Previous studies that evaluated concomitant vancomycin and piperacillin‐tazobactam found an increased risk of AKI with the combination compared with vancomycin alone or with cefepime . In our study, we found no statistically significant difference in the incidence of AKI between patients given vancomycin in combination with piperacillin‐tazobactam and those given vancomycin with cefepime.…”

“…Three published studies that evaluated the incidence of AKI with piperacillin‐tazobactam and vancomycin included a subset of patients with critical illness . One study compared two generic vancomycin products for potential differences in nephrotoxicity and used multivariate analysis of overall nephrotoxicity risk factors .…”

“…Until recently, the literature on nephrotoxicity associated with antipseudomonal β‐lactam antibiotics was limited to case reports . However, that body of literature has grown to include higher quality evidence …”

“…AKI is a clinical syndrome of various etiologies that leads to an abrupt decrease in kidney function . Although AKI associated with combination vancomycin and β‐lactam antibiotic therapy has been studied in non–critically ill hospitalized adults and a small subset of critically ill patients, to our knowledge, outcomes in an entirely critically ill patient population have not been reported. In two of the six studies, the combination of vancomycin and piperacillin‐tazobactam was not associated with an increased incidence of AKI compared with vancomycin and cefepime .…”

“…Although AKI associated with combination vancomycin and β‐lactam antibiotic therapy has been studied in non–critically ill hospitalized adults and a small subset of critically ill patients, to our knowledge, outcomes in an entirely critically ill patient population have not been reported. In two of the six studies, the combination of vancomycin and piperacillin‐tazobactam was not associated with an increased incidence of AKI compared with vancomycin and cefepime . However, in the other four studies, a higher proportion of patients who received concomitant vancomycin and piperacillin‐tazobactam developed AKI than those who received vancomycin alone or in combination with cefepime .…”