In patients who require intensive care unit (ICU) admission, the risk for acute kidney injury (AKI) is higher following combination treatment with vancomycin plus piperacillin-tazobactam compared with both vancomycin plus cefepime or vancomycin plus meropenem. These study results were published in Chest.

Researchers conducted a retrospective cohort study using data captured from patients across 335 hospitals who required ICU admission between 2010 and 2015. The researchers aimed to determine the risk for nephrotoxicity following treatment with different combinations of broad-spectrum empiric antibiotics. Eligible patients were older adults (mean age, 66 years) who received vancomycin in combination with either piperacillin-tazobactam (n=27,459; intervention), cefepime (n=6371; control), or meropenem (n=1824; control) following ICU admission. Propensity score matching was used to match patients in the intervention group against those in the control groups. The groups were balanced via inverse probability treatment weighting. The primary outcome was the occurrence of AKI within the first week of antibiotic treatment initiation. Mantel Haenszel and Cochran Mantel Haenszel chi-square testing were used to compare the risk for AKI between the matched groups.

Among patients included in all 3 cohorts, the most common reasons for ICU admission were sepsis (range, 44.9%-51.9%) and pneumonia (range, 9.9%-14.1%).

Continue Reading

The risk for AKI was significantly higher among patients who received combination treatment with piperacillin-tazobactam vs those who received combination treatment with cefepime (odds ratio [OR], 1.37; 95% CI, 1.25-1.49) or meropenem (OR, 1.27; 95% CI, 1.06-1.52). Further analysis showed that AKI risk was most increased for piperacillin-tazobactam recipients with normal kidney function at baseline who received continuous antibiotic treatment when compared with that of meropenem recipients who received prolonged treatment (OR, 3.23; 95% CI, 2.08-5.00).

Receipt of vancomycin plus piperacillin-tazobactam also was associated with increased risk for dialysis initiation when compared with both vancomycin plus cefepime (OR, 1.28; 95% CI, 1.14-1.45) and vancomycin plus meropenem (OR, 1.56; 95% CI, 1.23-2.00).

Study limitations include the retrospective design and the inability to accurately assess urine output and its effect on AKI risk.

According to the researchers, “clinicians should consider VM [vancomycin and meropenem] or VC [vancomycin and cefepime] to reduce risk of nephrotoxicity for ICU patients.”


Chen AY, Deng C-Y, Calvachi P, et al. A large-scale multi-center retrospective study on nephrotoxicity associated with empiric broad spectrum antibiotics in critically ill patientsChest. Published online April 9, 2023. doi:10.1016/j.chest.2023.03.046

This article originally appeared on Infectious Disease Advisor