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Comparison of the incidence of vancomycin-induced nephrotoxicity in hospitalized patients with and without concomitant piperacillin-tazobactam.

Publication ,  Journal Article
Burgess, LD; Drew, RH
Published in: Pharmacotherapy
July 2014

STUDY OBJECTIVES: To determine whether the addition of piperacillin-tazobactam leads to an increased incidence of nephrotoxicity in patients receiving vancomycin and to explore potential confounding factors that may increase the risk of vancomycin-induced nephrotoxicity. DESIGN: Single-center, retrospective cohort study. SETTING: Large, academic, tertiary-care hospital. PATIENTS: One hundred ninety-one adults hospitalized between July 1, 2009, and July 1, 2012, with normal baseline renal function who received a minimum of 48 hours of vancomycin for any indication were included in the analysis. Of these patients, 92 received a minimum of 48 hours of intravenous piperacillin-tazobactam concurrently with vancomycin, with piperacillin-tazobactam being initiated within 48 hours of the initiation of vancomycin (combination group); 99 received vancomycin without piperacillin-tazobactam (vancomycin group). MEASUREMENTS AND MAIN RESULTS: A univariate analysis was performed to assess the effect of the following risk factors on the incidence of nephrotoxicity within the first 7 days of vancomycin treatment: concomitant nephrotoxic agents, advanced age, steady-state vancomycin trough concentration of 15 μg/ml or greater, elevated Charlson Comorbidity Index, and a total daily vancomycin dose of 4 g or greater. A multivariate model was constructed to compare the incidence of the primary end point of nephrotoxicity, defined as a minimum 1.5-fold increase in serum creatinine concentration, between groups. Nephrotoxicity developed in 8 (8.1%) of 99 patients in the vancomycin group and in 15 (16.3%) of 92 patients in the combination group (1-sided χ(2) test, p=0.041). In the univariate analysis, only vancomycin trough concentration of 15 μg/ml or greater (odds ratio 3.67) was associated with an increased risk of developing nephrotoxicity. In the multivariate analysis, patients with piperacillin-tazobactam added to vancomycin exhibited an increased incidence of nephrotoxicity, with an odds ratio of 2.48 (1-sided χ(2) test, p=0.032). CONCLUSION: We observed an increased incidence of nephrotoxicity in vancomycin-treated patients who received concomitant piperacillin-tazobactam. A steady-state vancomycin trough concentration of 15 μg/ml or greater was also associated with an increased risk of the development of nephrotoxicity. These findings should be confirmed in larger, randomized studies.

Duke Scholars

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Published In

Pharmacotherapy

DOI

EISSN

1875-9114

Publication Date

July 2014

Volume

34

Issue

7

Start / End Page

670 / 676

Location

United States

Related Subject Headings

  • Vancomycin
  • Retrospective Studies
  • Piperacillin, Tazobactam Drug Combination
  • Piperacillin
  • Pharmacology & Pharmacy
  • Penicillanic Acid
  • Middle Aged
  • Male
  • Incidence
  • Humans
 

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Burgess, L. D., & Drew, R. H. (2014). Comparison of the incidence of vancomycin-induced nephrotoxicity in hospitalized patients with and without concomitant piperacillin-tazobactam. Pharmacotherapy, 34(7), 670–676. https://doi.org/10.1002/phar.1442
Burgess, Lindsey D., and Richard H. Drew. “Comparison of the incidence of vancomycin-induced nephrotoxicity in hospitalized patients with and without concomitant piperacillin-tazobactam.Pharmacotherapy 34, no. 7 (July 2014): 670–76. https://doi.org/10.1002/phar.1442.
Burgess, Lindsey D., and Richard H. Drew. “Comparison of the incidence of vancomycin-induced nephrotoxicity in hospitalized patients with and without concomitant piperacillin-tazobactam.Pharmacotherapy, vol. 34, no. 7, July 2014, pp. 670–76. Pubmed, doi:10.1002/phar.1442.
Journal cover image

Published In

Pharmacotherapy

DOI

EISSN

1875-9114

Publication Date

July 2014

Volume

34

Issue

7

Start / End Page

670 / 676

Location

United States

Related Subject Headings

  • Vancomycin
  • Retrospective Studies
  • Piperacillin, Tazobactam Drug Combination
  • Piperacillin
  • Pharmacology & Pharmacy
  • Penicillanic Acid
  • Middle Aged
  • Male
  • Incidence
  • Humans