• Mitchell S Buckley, Ivan A Komerdelj, Paul A D'Alessio, Pooja Rangan, Sumit K Agarwal, Nicole C Tinta, Brandon K Martinez, Delia S Ziadat, Melanie J Yerondopoulos, Emir Kobic, and Sandra L Kane-Gill.
• Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA. Electronic address: mitchell.buckley@bannerhealth.com.
• J Crit Care. 2022 Feb 1; 67: 134-140.

PurposeThe 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.Materials And MethodsA 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.ResultsA 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.ConclusionConcomitant vancomycin and piperacillin/tazobactam administration in adult ICU patients was independently associated with an increased risk of AKI.Copyright © 2021 Elsevier Inc. All rights reserved.

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