A Large-Scale Multicenter Retrospective Study on Nephrotoxicity Associated With Empiric Broad-Spectrum Antibiotics in Critically Ill Patients
Authors' conclusion
VPT is associated with a higher risk of acute kidney injury than both vancomycin and cefepime and vancomycin and meropenem in patients in the ICU, especially for patients with normal initial kidney function requiring longer durations of therapy.
Study context
- Population
- ICU patients receiving empiric vancomycin plus piperacillin-tazobactam, cefepime or meropenem exclusively; eICU Research Institute, 335 hospitals, 2010–2015
- Participants
- 35,654 patients
- Exposure
- Vancomycin and piperacillin-tazobactam vs vancomycin and cefepime or vancomycin and meropenem
- Vancomycin and piperacillin-tazobactamn = 27,459
- Vancomycin and cefepimen = 6,371reference
- Vancomycin and meropenemn = 1,824reference
- Outcome
- AKI (KDIGO stage 2 or 3 by serum creatinine)
Methodological detailspropensity score matching, multicentre
- Propensity score matching
- Multicentre
Main finding
As reported in the abstract
AKI
Odds ratio (95% CI)
Vancomycin and piperacillin-tazobactam vs Vancomycin and cefepime
1.37(1.25–1.49)
Vancomycin and piperacillin-tazobactam vs Vancomycin and meropenem
1.27(1.06–1.52)
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| Initiation of dialysisVancomycin and piperacillin-tazobactam vs Vancomycin and cefepime | 1.28 (1.14–1.45) | |
| Initiation of dialysisVancomycin and piperacillin-tazobactam vs Vancomycin and meropenem | 1.56 (1.23–2.00) | |
| 0.512Odds ratio (log scale) |
AKI, patients without renal insufficiency on longer therapy (sensitivity analysis)
- Odds of AKI especially pronounced with longer vancomycin and piperacillin-tazobactam vs vancomycin and meropenem therapy
Original publication
A Large-Scale Multicenter Retrospective Study on Nephrotoxicity Associated With Empiric Broad-Spectrum Antibiotics in Critically Ill Patients. Chest. Published 9 April 2023. doi:10.
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