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Comparative incidence and excess risk of acute kidney injury in hospitalised patients receiving vancomycin and piperacillin/tazobactam in combination or as monotherapy.
- Source :
-
International journal of antimicrobial agents [Int J Antimicrob Agents] 2018 Nov; Vol. 52 (5), pp. 643-650. Date of Electronic Publication: 2018 Aug 10. - Publication Year :
- 2018
-
Abstract
- Combination therapy with vancomycin and piperacillin/tazobactam (TZP) has been associated with increased risk of acute kidney injury (AKI) compared with monotherapy with either agent. This retrospective, matched cohort study was conducted to assess the comparative incidence of AKI due to combination therapy in patients receiving vancomycin and TZP in combination or as monotherapy. Patients aged ≥18 years admitted to Albany Medical Center (Albany, NY) between September 2013 and August 2014 who had received therapy for at least two consecutive days were included. Patients who were pregnant, neutropenic, had AKI on admission or with cystic fibrosis were excluded. Patients were matched on baseline risk of AKI. The main outcome of interest was AKI, defined as an increase in serum creatinine of ≥0.3 mg/L or ≥50% within 48 h. Secondary outcomes evaluated were length of hospital and ICU stay and inpatient mortality associated with AKI. The risk of AKI was 7.0%, 8.5% and 26.8% in the vancomycin monotherapy, TZP monotherapy and combination groups, respectively (P < 0.001). In the multivariate analysis, combination therapy was independently associated with an increased odds of AKI (adjusted odds ratio = 4.406, 95% confidence interval 1.472-13.188) compared with vancomycin monotherapy. The excess risk of combination therapy was 11.3%. In this matched cohort study, there was an increased incidence of AKI in patients receiving vancomycin and TZP combination therapy. Further research is needed to determine the individual strategies to best prevent inpatient AKI in patients receiving this combination therapy.<br /> (Copyright © 2018 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.)
- Subjects :
- Academic Medical Centers
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents administration & dosage
Creatinine blood
Drug Therapy methods
Drug-Related Side Effects and Adverse Reactions epidemiology
Drug-Related Side Effects and Adverse Reactions pathology
Female
Hospital Mortality
Humans
Incidence
Length of Stay
Male
Middle Aged
New York epidemiology
Piperacillin administration & dosage
Retrospective Studies
Risk Assessment
Tazobactam administration & dosage
Vancomycin administration & dosage
Young Adult
beta-Lactamase Inhibitors administration & dosage
Acute Kidney Injury chemically induced
Acute Kidney Injury epidemiology
Anti-Bacterial Agents adverse effects
Piperacillin adverse effects
Tazobactam adverse effects
Vancomycin adverse effects
beta-Lactamase Inhibitors adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1872-7913
- Volume :
- 52
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- International journal of antimicrobial agents
- Publication Type :
- Academic Journal
- Accession number :
- 30103003
- Full Text :
- https://doi.org/10.1016/j.ijantimicag.2018.08.001