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Kidney Week

Abstract: SA-OR008

Risk of AKI Among Critically Ill Patients with Concomitant Use of Vancomycin and Piperacillin-Tazobactam: A Meta-Analysis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Tang, Mengyao, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Cherian, Jerald, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Kalim, Sahir, Massachusetts General Hospital/ Harvard Medical School, Cambridge, Massachusetts, United States
Background

Multiple studies have demonstrated that the combination of vancomycin and piperacillin-tazobactam (VPZ) is associated with increased risk of AKI compared to the combination of vancomycin and cefepime (VC) in the general population. Whether this holds true for critically ill patients is particularly important, given that AKI is very common in this population and is associated with increased mortality. Currently the data in critically ill patients is limited and the effect of VPZ in this population is controversial. Thus, the goal of this study was to determine the association between VPZ and AKI in critically ill adults.

Methods

A meta-analysis of observational studies that enrolled critically ill patients receiving VPZ or VC in the ICU setting was conducted. Electronic databases (PubMed, Cochrane and Embase) were searched through April 2019. Effect estimates and 95% CIs were pooled using the random effects model in STATA. The primary outcome was AKI as defined by the individual study. The secondary outcome was time to AKI.

Results

Literature search identified 6 published studies with 6764 patients. The definition of AKI was based on RIFLE, KDIGO or AKIN criteria. The odds of AKI in the VPZ group were higher compared to the VC group (odds ratio, 1.50; 95% CI 1.29-1.76; p<0.001) (Figure 1). There was no difference in the time to AKI between the VPZ group and the VC group (mean difference, -0.06; 95% CI, -0.09 to 0.74 days).

Conclusion

In critically ill patients, concomitant use of vancomycin and piperacillin-tazobactam is associated with an increased risk of AKI just as in the general population. This finding should be taken into consideration when choosing empiric antimicrobial coverage for critically ill patients. The included studies demonstrated some heterogeneity. Thus, future research regarding the use of VPZ in critically ill patients is warranted to confirm these findings.

Forest plot demonstrating the odds ratio of AKI in critically ill patients