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Venugopalan V, Maranchick N, Hanai D, Hernandez YJ, Joseph Y, Gore A, Desear K, Peloquin C, Neely M, Felton T, Shoulders B, Alshaer M. Association of piperacillin and vancomycin exposure on acute kidney injury during combination therapy. JAC Antimicrob Resist 2024; 6:dlad157. [PMID: 38259903 PMCID: PMC10801827 DOI: 10.1093/jacamr/dlad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Objectives Acute kidney injury (AKI) is a well-documented adverse effect observed with piperacillin/tazobactam in combination with vancomycin. The pharmacokinetics of these antibiotics when given in combination have not been previously evaluated. The purpose of this study was to compare the exposure of vancomycin + piperacillin/tazobactam in patients with and without AKI. Methods Ninety adult patients, who received at least 72 h of vancomycin + piperacillin/tazobactam combination therapy and had available serum concentrations of vancomycin and piperacillin were included in the study. Nephrotoxicity was defined as a 1.5-fold increase in serum creatinine within 7 days from baseline. Median daily AUCs were calculated in those with nephrotoxicity (vancomycin + piperacillin/tazobactam 'N') versus those without nephrotoxicity (vancomycin + piperacillin/tazobactam 'WN') during the first 7 days of combination therapy. Results The overall incidence of AKI in those receiving vancomycin + piperacillin/tazobactam was 20% (18/90). The median daily vancomycin AUCs did not differ between the vancomycin + piperacillin/tazobactam 'WN' and vancomycin + piperacillin/tazobactam 'N' groups. Although not statistically significant, the median daily vancomycin AUCs in the vancomycin + piperacillin/tazobactam 'N' group were numerically greater on Day 5 and trended downwards thereafter. For the piperacillin group, the median daily AUCs did not vary between groups, except on Day 7 where the vancomycin + piperacillin/tazobactam 'WN' group had statistically greater median piperacillin AUC than the vancomycin + piperacillin/tazobactam 'N' group (P = 0.046). Conclusions Utilizing serum creatinine-defined AKI, our study did not find any significant differences in vancomycin and piperacillin/tazobactam exposure between the groups with and without nephrotoxicity. These data indicate that vancomycin + piperacillin/tazobactam should not be avoided due to the risk of overexposure; instead, clinicians should continue to use these therapies cautiously.
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Affiliation(s)
- Veena Venugopalan
- Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL, USA
- Department of Pharmacy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Nicole Maranchick
- Department of Pharmacy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Devorah Hanai
- Department of Pharmacy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Yaima Jimenez Hernandez
- Department of Pharmacy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Yuliya Joseph
- Department of Pharmacy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Amanda Gore
- Department of Pharmacy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Kathryn Desear
- Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL, USA
| | - Charles Peloquin
- Department of Pharmacy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Michael Neely
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Timothy Felton
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Bethany Shoulders
- Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL, USA
- Department of Pharmacy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Mohammad Alshaer
- Department of Pharmacy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
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