Journal article
Risk of Acute Kidney Injury and Clostridioides difficile Infection With Piperacillin/Tazobactam, Cefepime, and Meropenem With or Without Vancomycin
Clinical infectious diseases, Vol.73(7), pp.E1579-E1586
10/01/2021
DOI: 10.1093/cid/ciaa1902
PMID: 33382398
Abstract
Background. Empiric antimicrobial therapy for healthcare-acquired infections often includes vancomycin plus an antipseudomonal beta-lactam (AP-BL). These agents vary in risk for adverse events, including acute kidney injury (AKI) and Clostrioides difficile infection (CDI). Studies have only examined these risks separately; thus, our objective was to evaluate AKI and CDI risks simultaneously with AP-BL in the same patient cohort.
Methods. This retrospective cohort study included 789 200 Veterans Health Administration medical admissions from 1 July 2010 through 30 June 2016. The antimicrobials examined were vancomycin, cefepime, piperacillin/tazobactam, and meropenem. Cox proportional hazards regression was used to contrast risks for AKI and CDI across individual target antimicrobials and vancomycin combination therapies, including adjustment for known confounders.
Results. With respect to the base rate of AKI among patients who did not receive a target antibiotic (4.6%), the adjusted hazards ratios for piperacillin/tazobactam, cefepime, and meropenem were 1.50 (95% CI: 1.43-1.54), 1.00 (.95-1.05), 0.92 (.83-1.01), respectively. Co-administration of vancomycin increased AKI rates (data not shown). Similarly, against the base rate of CDI (0.7%), these ratios were 1.21 (1.07-1.36), 1.89 (1.62-2.20), and 1.99 (1.55-2.56), respectively. Addition of vancomycin had minimal impact on CDI rates (data not shown).
Conclusions. Piperacillin/tazobactam increased AKI risk, which was exacerbated by concurrent vancomycin. Cefepime and meropenem increased CDI risk relative to piperacillin/tazobactam. Clinicians should consider the risks and benefits of AP-BL when selecting empiric regimens. Further well-designed studies evaluating the global risks of AP-BL and patient specific characteristics that can guide empiric selection are needed.
Details
- Title: Subtitle
- Risk of Acute Kidney Injury and Clostridioides difficile Infection With Piperacillin/Tazobactam, Cefepime, and Meropenem With or Without Vancomycin
- Creators
- Jazmin D. Lee - Iowa City VA Health Care SystemBrett H. Heintz - Iowa City VA Health Care SystemHilary J. Mosher - Iowa City VA Health Care SystemDaniel J. Livorsi - Iowa City VA Health Care SystemJason A. Egge - Iowa City VA Health Care SystemBrian C. Lund - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- Clinical infectious diseases, Vol.73(7), pp.E1579-E1586
- DOI
- 10.1093/cid/ciaa1902
- PMID
- 33382398
- NLM abbreviation
- Clin Infect Dis
- ISSN
- 1058-4838
- eISSN
- 1537-6591
- Publisher
- Oxford Univ Press
- Number of pages
- 8
- Grant note
- CIN 13-412 / Health Services Research and Development Service, Department of Veterans Affairs; US Department of Veterans Affairs Iowa City VA Health Care System, Department of Pharmacy Services
- Language
- English
- Date published
- 10/01/2021
- Academic Unit
- Infectious Diseases; Epidemiology; Emergency Medicine; Pharmacy Practice and Science; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359949902771
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