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Comparative renal risk of long-term use of beta-lactams in combination with vancomycin across the continuum of care

BACKGROUND: Data are controversial regarding nephrotoxicity risk with vancomycin plus piperacillin–tazobactam (VPT) compared to vancomycin alone or in combination with other beta-lactams (BLs) in acute care use. Furthermore, data are lacking on the incidence of acute kidney injury (AKI) with long-te...

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Autores principales: Dolly, Lauren M., Rivera, Christina G., Jensen, Kelsey L., Mara, Kristin C., Schreier, Diana J., Virk, Abinash, Arensman Hannan, Kellie N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10422906/
https://www.ncbi.nlm.nih.gov/pubmed/37576023
http://dx.doi.org/10.1177/20499361231189589
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author Dolly, Lauren M.
Rivera, Christina G.
Jensen, Kelsey L.
Mara, Kristin C.
Schreier, Diana J.
Virk, Abinash
Arensman Hannan, Kellie N.
author_facet Dolly, Lauren M.
Rivera, Christina G.
Jensen, Kelsey L.
Mara, Kristin C.
Schreier, Diana J.
Virk, Abinash
Arensman Hannan, Kellie N.
author_sort Dolly, Lauren M.
collection PubMed
description BACKGROUND: Data are controversial regarding nephrotoxicity risk with vancomycin plus piperacillin–tazobactam (VPT) compared to vancomycin alone or in combination with other beta-lactams (BLs) in acute care use. Furthermore, data are lacking on the incidence of acute kidney injury (AKI) with long-term use of VPT including outpatient parenteral antimicrobial therapy (OPAT). METHODS: This retrospective study included 826 adult patients on an intravenous vancomycin plus BL for ⩾2 weeks, including cefepime, piperacillin/tazobactam, ertapenem, or meropenem, from August 2017 to January 2022. The primary outcome was incidence of AKI. Univariate and multivariable Cox proportional hazard regression analyses were conducted to adjust for confounding variables. A secondary analysis based on the propensity score (PS)-matched cohort was performed. RESULTS: AKI occurred in 14.4% of patients in the VPT group (n = 15/104) compared to 5.5% in the other BL group (n = 40/722) (p < 0.001). Average time to AKI from start of combination therapy was 9.4 (1.7–12.0) days in the VPT group and 10.9 (5–22.7) days in the other BL group (p = 0.20). The median duration of vancomycin and BL in the overall cohort was approximately 1 month. Beyond BL selection, patient characteristics were not associated with AKI other than the receipt of concomitant acyclovir [hazard ratio (HR) 2.48 (95% confidence interval (CI): 1.33–4.65), p = 0.004]. In the PS-matched cohort, AKI occurred in 14.4% of patients in the VPT group (n = 15/104) and 5.3% in the other BL group (n = 11/208) (p = 0.006). Receipt of VPT [HR: 2.55 (1.36–4.78), p = 0.004] and acyclovir [HR: 2.38 (1.19–4.74), p = 0.014) remained significantly associated with AKI in the multivariable model. CONCLUSION: Clinicians should exercise caution when using VPT for >2 weeks, including in the OPAT setting, even when no renal dysfunction is observed during the initial week of combination therapy.
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spelling pubmed-104229062023-08-13 Comparative renal risk of long-term use of beta-lactams in combination with vancomycin across the continuum of care Dolly, Lauren M. Rivera, Christina G. Jensen, Kelsey L. Mara, Kristin C. Schreier, Diana J. Virk, Abinash Arensman Hannan, Kellie N. Ther Adv Infect Dis Outpatient Parenteral Antimicrobial Therapy BACKGROUND: Data are controversial regarding nephrotoxicity risk with vancomycin plus piperacillin–tazobactam (VPT) compared to vancomycin alone or in combination with other beta-lactams (BLs) in acute care use. Furthermore, data are lacking on the incidence of acute kidney injury (AKI) with long-term use of VPT including outpatient parenteral antimicrobial therapy (OPAT). METHODS: This retrospective study included 826 adult patients on an intravenous vancomycin plus BL for ⩾2 weeks, including cefepime, piperacillin/tazobactam, ertapenem, or meropenem, from August 2017 to January 2022. The primary outcome was incidence of AKI. Univariate and multivariable Cox proportional hazard regression analyses were conducted to adjust for confounding variables. A secondary analysis based on the propensity score (PS)-matched cohort was performed. RESULTS: AKI occurred in 14.4% of patients in the VPT group (n = 15/104) compared to 5.5% in the other BL group (n = 40/722) (p < 0.001). Average time to AKI from start of combination therapy was 9.4 (1.7–12.0) days in the VPT group and 10.9 (5–22.7) days in the other BL group (p = 0.20). The median duration of vancomycin and BL in the overall cohort was approximately 1 month. Beyond BL selection, patient characteristics were not associated with AKI other than the receipt of concomitant acyclovir [hazard ratio (HR) 2.48 (95% confidence interval (CI): 1.33–4.65), p = 0.004]. In the PS-matched cohort, AKI occurred in 14.4% of patients in the VPT group (n = 15/104) and 5.3% in the other BL group (n = 11/208) (p = 0.006). Receipt of VPT [HR: 2.55 (1.36–4.78), p = 0.004] and acyclovir [HR: 2.38 (1.19–4.74), p = 0.014) remained significantly associated with AKI in the multivariable model. CONCLUSION: Clinicians should exercise caution when using VPT for >2 weeks, including in the OPAT setting, even when no renal dysfunction is observed during the initial week of combination therapy. SAGE Publications 2023-08-11 /pmc/articles/PMC10422906/ /pubmed/37576023 http://dx.doi.org/10.1177/20499361231189589 Text en © The Author(s), 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Outpatient Parenteral Antimicrobial Therapy
Dolly, Lauren M.
Rivera, Christina G.
Jensen, Kelsey L.
Mara, Kristin C.
Schreier, Diana J.
Virk, Abinash
Arensman Hannan, Kellie N.
Comparative renal risk of long-term use of beta-lactams in combination with vancomycin across the continuum of care
title Comparative renal risk of long-term use of beta-lactams in combination with vancomycin across the continuum of care
title_full Comparative renal risk of long-term use of beta-lactams in combination with vancomycin across the continuum of care
title_fullStr Comparative renal risk of long-term use of beta-lactams in combination with vancomycin across the continuum of care
title_full_unstemmed Comparative renal risk of long-term use of beta-lactams in combination with vancomycin across the continuum of care
title_short Comparative renal risk of long-term use of beta-lactams in combination with vancomycin across the continuum of care
title_sort comparative renal risk of long-term use of beta-lactams in combination with vancomycin across the continuum of care
topic Outpatient Parenteral Antimicrobial Therapy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10422906/
https://www.ncbi.nlm.nih.gov/pubmed/37576023
http://dx.doi.org/10.1177/20499361231189589
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