Comparative analysis of acute kidney injury incidence in Hispanic patients receiving empiric vancomycin and piperacillin/tazobactam versus vancomycin and cefepime.

PURPOSE: To explore whether the vancomycin plus piperacillin/tazobactam (VPT) combination increased risk of acute kidney injury (AKI) compared to vancomycin plus cefepime (VC) in a cohort of Hispanic patients.

METHODS

This was a single-center, retrospective study. Adult Hispanic patients receiving at least 48 hours of concomitant vancomycin and (-lactam therapy were included. Patients were excluded if they had documented allergies to study antibiotics, had antibiotics indicated for a central nervous system infection, were pregnant, had cystic fibrosis, a malignancy, or a creatinine clearance level of 30 mL/min or less, or had preexisting AKI within 48 hours before initiation of antibiotics. The primary outcome was the incidence of AKI, defined by a rise in serum creatinine level as described in KDIGO guidelines. A subgroup analysis was performed to assess AKI incidence with stratification into 3 vancomycin area under the curve (AUC) ranges: 400-499 mg · h/L, 500-599 mg · h/L, and ≥600 mg · h/L.

RESULTS

A total of 89 patients were included in the study: 45 in the VPT group and 44 in the VC group. AKI occurred in 23 of the patients receiving VPT (51%) compared to 10 of the patients receiving VC (23%) (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.22-4.16; P = 0.006). For the subgroup analysis, a significant difference was seen in AKI between VPT and VC in the subgroup with a vancomycin AUC of 400-499 mg · h/L (OR, 0.303; 95% CI, 0.102-0.897; P = 0.035).

CONCLUSION

This study suggests that there might be higher risk of AKI with VPT in the Hispanic population. Further studies are needed to confirm these findings and to investigate potential ethnicity-specific susceptibility to kidney injury associated with vancomycin combination therapy.