No significant difference was seen in the incidence of acute kidney injury (AKI) development or other outcomes between patients who received vancomycin + piperacillin-tazobactam vs. vancomcyin + cefepime, findings from a study published in Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy have shown.

Vancomycin + piperacillin-tazobactam combination therapy has been linked to a higher risk of AKI in non-critically ill patients. However, whether this association exists in critically ill patients is still unknown. Researchers from University of Arkansas conducted a retrospective cohort study to compare the incidence of AKI development during therapy or within 72 hours after therapy completion in critically ill adults who received vancomycin with piperacillin-tazobactam or cefepime.

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A total of 122 critically ill patients who received ≥48 hours of combination therapy with vancomycin + piperacillin-tazobactam (n=49) or vancomycin + cefepime (n=73) during ICU admission were included in the study. The primary outcome was AKI development during therapy or within 72 hours of therapy completion. 


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Of the total patients, 37 (30.3%) developed AKI. The unadjusted analysis indicated the incidence of AKI was similar in the piperacillin-tazobactam group vs. the cefepime group (32.7% vs. 28.8%; P=0.647). Average treatment effect between the two arms was not significant with no association between the choice of beta-lactam and AKI (P=0.958). Furthermore, the choice of the beta-lactam agent was not a significant predictor of the following secondary outcomes: ICU length of stay (P=0.780), hospital length of stay (P=0.125), AKI duration (P=0.283), and need for renal replacement therapy (P=0.161). 

Previous findings that have shown combination vancomycin + piperacillin-tazobactam increase AKI in non-critically ill patients may not generally apply to the critically ill population, and a prospective assessment of this hypothesis is needed, researchers concluded.

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