Risk of Acute Kidney Injury and Clostridioides difficile Infection With Piperacillin/Tazobactam, Cefepime, and Meropenem With or Without Vancomycin
| Autor: | Brian C. Lund, Brett H. Heintz, Hilary J Mosher, Jazmin D Lee, Daniel J Livorsi, Jason A Egge |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty Cefepime 030106 microbiology Tazobactam Meropenem 03 medical and health sciences 0302 clinical medicine Clostridioides Vancomycin Internal medicine medicine Humans 030212 general & internal medicine Retrospective Studies Piperacillin business.industry Retrospective cohort study Acute Kidney Injury Anti-Bacterial Agents Infectious Diseases Piperacillin Tazobactam Drug Combination Piperacillin/tazobactam Drug Therapy Combination business Empiric therapy medicine.drug |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 73(7) |
| ISSN: | 1537-6591 |
| Popis: | BackgroundEmpiric antimicrobial therapy for healthcare-acquired infections often includes vancomycin plus an anti-pseudomonal beta-lactam (AP-BL). These agents vary in risk for adverse events, including acute kidney injury (AKI) and Clostrioides difficile infection (CDI). Studies have only examined these risks separately; thus, our objective was to evaluate AKI and CDI risks simultaneously with AP-BL in the same patient cohort.MethodsThis retrospective cohort study included 789 200 Veterans Health Administration medical admissions from 1 July 2010 through 30 June 2016. The antimicrobials examined were vancomycin, cefepime, piperacillin/tazobactam, and meropenem. Cox proportional hazards regression was used to contrast risks for AKI and CDI across individual target antimicrobials and vancomycin combination therapies, including adjustment for known confounders.ResultsWith respect to the base rate of AKI among patients who did not receive a target antibiotic (4.6%), the adjusted hazards ratios for piperacillin/tazobactam, cefepime, and meropenem were 1.50 (95% CI: 1.43–1.54), 1.00 (.95–1.05), 0.92 (.83–1.01), respectively. Co-administration of vancomycin increased AKI rates (data not shown). Similarly, against the base rate of CDI (0.7%), these ratios were 1.21 (1.07–1.36), 1.89 (1.62–2.20), and 1.99 (1.55–2.56), respectively. Addition of vancomycin had minimal impact on CDI rates (data not shown).ConclusionsPiperacillin/tazobactam increased AKI risk, which was exacerbated by concurrent vancomycin. Cefepime and meropenem increased CDI risk relative to piperacillin/tazobactam. Clinicians should consider the risks and benefits of AP-BL when selecting empiric regimens. Further well-designed studies evaluating the global risks of AP-BL and patient specific characteristics that can guide empiric selection are needed. |
| Databáze: | OpenAIRE |
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