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Acute Kidney Injury in Patients Treated with IV Beta‐Lactam/Beta‐Lactamase Inhibitor Combinations
Author(s) -
Rutter W. Cliff,
Burgess David S.
Publication year - 2017
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1918
Subject(s) - medicine , acute kidney injury , nephrotoxicity , odds ratio , renal function , creatinine , kidney disease , gastroenterology , retrospective cohort study , incidence (geometry) , kidney , physics , optics
Study Objective Increased acute kidney injury ( AKI ) incidence has been reported in patients receiving piperacillin‐tazobactam ( PTZ ) therapy compared with other β‐lactams. The authors sought to determine if the addition of β‐lactamase inhibitors impacts AKI incidence by comparing patients treated with PTZ or ampicillin‐sulbactam ( SAM ). Design Retrospective cohort study. Setting Large academic tertiary care hospital. Patients Overall, 2448 patients received PTZ (n=1836) or SAM (n=612) for at least 48 hours between September 1, 2007, and September 30, 2015. Patients were excluded for pregnancy, cystic fibrosis, chronic kidney disease, and initial creatinine clearance < 30 ml/min. Patients were matched on Charlson Comorbidity Index, initial creatinine clearance, hypotension exposure, various nephrotoxic drug exposures, history of diabetes, heart failure, and hypertension. Measurements and Main results AKI occurred in 265 patients at similar rates for both groups ( PTZ 11.4% vs SAM 9.2%; p=0.14). After stratifying by vancomycin exposure and controlling for confounders, there was no difference in the risk of AKI for SAM or PTZ (adjusted odds ratio [aOR] 0.87, 95% confidence interval [CI] 0.59–1.25). The addition of vancomycin (VAN) to PTZ increased the likelihood of AKI compared with PTZ alone (a OR 1.77, 95% CI 1.26–2.46). Concomitant SAM and VAN therapy was not associated with a significant increase in AKI compared with SAM monotherapy (aOR 1.01, 95% CI 0.48–1.97). Conclusion Rates of AKI were similar for PTZ and SAM in a matched cohort. The addition of a β‐lactamase inhibitor is not likely the mechanism in the observed increased rates of AKI in patients treated with vancomycin and PTZ .