The impact of vancomycin and piperacillin-tazobactam combination therapy on the incidence of acute kidney injury: a retrospective review

BACKGROUND: In the last decade, there has been increased concern for nephrotoxicity and an association with acute kidney injury (AKI) in patients treated with vancomycin-piperacillin/tazobactam (VPT). METHODS: This single-center retrospective observational study evaluated the incidence of AKI between those receiving VPT therapy versus those receiving vancomycin-cefepime (VC), while also evaluating for possible confounding variables and the initiation of renal replacement therapy. The study included patients prescribed VPT or VC from January 1, 2019, to July 31, 2023, using the KDIGO AKI definition to determine if patients had AKI within 48 hours or 7 days of treatment. RESULTS: A total of 581 patients were identified in the VPT group and 1950 in the VC group. Each group had similar demographic makeup. The incidence of AKI in the VPT group was 30 patients (10.56%) at 48 hours, and 45 patients (15.85%) at 7 days. The incidence of AKI in the VC group was 24 patients (5.14%) at 48 hours and 27 (5.78%) at 7 days. CONCLUSION: Patients in the VPT group had an increased incidence of AKI. Additionally, significantly more patients in the VPT group progressed to requiring renal replacement therapy compared to those treated with VC.