1382. Acute Kidney Injury with Piperacillin–tazobactam and Vancomycin in the Intensive Care Unit

Background Several recent retrospective studies have suggested that the combination of vancomycin (V) with piperacillin–tazobactam (PTZ) is associated with increased nephrotoxicity. We prospectively evaluated the outcomes of patients admitted to all of our medical and surgical intensive care units (ICU) with a normal baseline creatinine clearance (CrCl) that received vancomycin in combination with either cefepime (CEF) or PTZ to determine whether kidney injury occurs using RIFLE criteria. Methods ICU patients who received combinations of V with either PTZ or CEF were prospectively evaluated from June 1, 2017 to April 28, 2018 using Theradoc. V and PTZ dosing were standardized per ICU policy and monitored by clinical pharmacists. We included patients between ages 18 and 90, and receipt of >72 hours of combination antibiotic therapy. We excluded patients that were pregnant, had a hematologic malignancy, chronic kidney disease, or neuromuscular disease. Data collected included, CrCl, V troughs, dosage and length of all antibiotics used, ICU length of stay (LOS), and co-administered nephrotoxic medications (e.g., NSAIDs and IV contrast). The primary objective was to compare the incidence of AKI in these study groups, as defined by the RIFLE criteria. Results Of 233 patients evaluated, 58 (25%) met inclusion criteria, 45 received PTZ-V and 13 CEF-V. Only eight of 58 (14%) MRSA-positive culture.Table 1: Data Summary PTZ-V CEF-V P-value Age (median, range) 58 (35–84) 64 (18–79) 0.54 Gender (male) 30 (67%) 7 (54%) 0.51 Median weight (kg) 86 (54–136) 82.4 (51–156) 0.6 No > 100 kg 11 (24%) 3 (23%) 1 No V trough >20 2 (4%) 1 (8%) 0.6 Median V trough(range) 11.4 (5.4–32.7) 10.6 (6.4–29.5) 0.695 Median V days (range) 5 (3–16) 4 (3–13) 0.99 Co-admin nephrotoxic agent 41 (91%) 11 (85%) 0.61 ICU LOS 11 (4–36) 14 (3–32) 0.35 Hospital LOS 15 (4–36) 20 (6–72) 0.037 No. AKI by RIFLE 13 0 0.028 We found no correlation with co-administered nephrotoxic agents, vancomycin troughs, or body weight and AKI. Conclusion Our prospective observational study data revealed significant AKI with PTZ-V compared with CEF-V but it did not impact patient long-term outcomes. Caution with PTZ-V may be required when used in ICU settings even in patients with normal baseline CrCl. Disclosures J. S. Lewis II, Merck: Consultant, Consulting fee.