Category: Professional Posters
Purpose: Intermittent piperacillin-tazobactam has been extensively used in conjunction with intravenous vancomycin to ensure adequate coverage of pathogens. However, this combination has been associated with acute kidney injury (AKI). Recently, Extended-infusion (EI) piperacillin/tazobactam has been adopted at many institutions to optimize its pharmacokinetic and pharmacodynamic properties. Nephrotoxicity associated with EI is not well documented and current literature has been predominately retrospective reviews. The purpose of this study was to evaluate the incidence of AKI with combination of intravenous vancomycin and EI piperacillin/tazobactam.
Methods: The institutional review board approved this single-center prospective chart review. Patients who received concomitant intravenous vancomycin and EI piperacillin/tazobactam during their hospitalization were identified through a monitoring queue in the electronic health record. They were screened and excluded if less than three doses of either antimicrobial were administered concomitantly, the patient had end-stage renal disease, or was receiving renal replacement therapy at time of initiation of therapy. The primary outcome was the incidence of AKI in patients treated with the study therapy. AKI was defined by the Kidney Disease Improving Global Outcomes definition of the Risk, Injury, Failure, Loss, End-Stage (RIFLE) and Acute Kidney Injury Network (AKIN) criteria. Secondary outcomes included the number of patients who needed dose adjustment due to decline in renal function, number of recommendations made by pharmacy for dose adjustment and percentage of recommendations accepted, onset of AKI following administration and incidence of AKI resolution after discontinuation of study therapy.
Results: A total of 17 patients were identified from February and March of 2019. In patients treated with concomitant intravenous vancomycin and EI piperacillin/tazobactam, AKI occurred in 1 of 17 patients (6%). Dose adjustments due to decline in renal function were required in 3 patients (17.6%) and 7 of 11 (63.6%) recommendations for renal dose adjustment were accepted. Onset of AKI following administration was 1 day and the AKI resolved after discontinuation of therapy.
Conclusion: Many previous retrospective studies showed similar rates of AKI in patients treated with concomitant intravenous vancomycin and EI piperacillin/tazobactam compared with intermittent piperacillin/tazobactam. In addition, this review demonstrated low incidence of AKI with the use of combination intravenous vancomycin and EI piperacillin/tazobactam. This review provides prospective analysis in evaluating AKI in patients treated with the EI dosing strategy.