Incidence of acute kidney injury among patients treated with piperacillin-tazobactam or meropenem in combination with vancomycin

Acute kidney injury (AKI) increases during empirical antimicrobial therapy with the combination of piperacillin-tazobactam (TZP) and vancomycin (VAN) compared to the number of incidences with monotherapy or the combination of cefepime and VAN. Limited data regarding the impact of meropenem (MEM) combined with VAN exist. This study examined the AKI incidence among patients treated with MEM plus VAN (MEMVAN) or TZPVAN. Data were collected from the University of Kentucky Center for Clinical and Translational Science Enterprise Data Trust from September 2007 through October 2015. Adults without previous renal disease who received MEMVAN or TZPVAN for at least 2 days were included. AKI was assessed using risk, injury, failure, loss, and end-stage (RIFLE) criteria. Inverse probability of treatment weighting was utilized to control for differences between groups. In total, 10,236 patients met inclusion criteria, with 9,898 receiving TZPVAN and 338 receiving MEMVAN. AKI occurred in 15.4% of MEMVAN patients and in 27.4% of TZPVAN patients (P 0.001). TZPVAN was associated with increased AKI compared to the level with MEMVAN (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.82 to 3.52), after controlling for confounders. Use of MEMVAN should be considered an appropriate alternative therapy to TZPVAN if nephrotoxicity is a major concern. The results of this study demonstrate that judicial use of TZPVAN for empirical coverage of infection is needed.