Category: Professional Posters
Purpose: From March 2018 to March 2019, the hospital experienced eight cases of acute kidney injury (AKI) associated with the combination use of IV vancomycin and piperacillin/tazobactam. The antimicrobial stewardship team, with the support of hospital leadership, chose to restrict the use of piperacillin/tazobactam in combination with vancomycin in an effort to decrease risk in future patients.
Methods: All eight patients presented with normal renal function, SCr 1mg/dl or less, were treated for skin and soft tissue infections (SSTIs), and seven of the patients were under the age of 50. Within days of antimicrobial initiation, seven of the eight patients required short term dialysis for a duration of two weeks to four months. In January 2019, a prohibition on ordering the combination of vancomycin and piperacillin/tazobactam for the treatment of SSTI was approved by the stewardship team and Pharmacy and Therapeutics Committee. Education was provided to all emergency room providers and hospitalists in January 2019 regarding the dangers of the combination. Education included alternative therapies for the most common uses of piperacillin/tazobactam and vancomycin. In April 2019, all prescribers were instructed to stop using the combination in all patients as directed by hospital leadership and approved by the hospital’s medical executive committee. The pharmacy department monitors all vancomycin orders to ensure the prohibition is upheld and all vancomycin patients are monitored continuously for renal function changes. To determine the impact of these interventions, utilization was assessed before and after implementation via days of therapy per 1000 patient days (DOT/1000 PD).
Results: Following the education in January 2019, one case of AKI was noted in March 2019. Subsequently another round of education was provided in April, with stronger language prohibiting the use of this drug combination in any patient. No acute renal injury has been noted in patients receiving vancomycin during this time period. Vancomycin use has decreased 37% this year compared to 2018 (DOT/1000 PD 55 vs. 87). Piperacillin/tazobactam use has decreased 41% in 2019 compared to 2018 (DOT/1000 PD 82 vs. 138). Overall antibiotic DOT/1000 PD decreased by 3% in 2019 compared to 2018.
Conclusion: The prohibition on the use of vancomycin in combination with piperacillin/tazobactam arrested a cluster of acute kidney injuries at a community hospital. No further vancomycin associated acute kidney injury has been reported.