Pharmacy, Health Sciences & Exercise Science
Retrospective Comparative Cohort of Concomitant Piperacillin-Tazobactam and Vancomycin Use and Acute Kidney Injury
Document Type
Oral Presentation
Location
Indianapolis, IN
Subject Area
Pharmacy, Health Sciences & Exercise Science
Start Date
10-4-2015 10:45 AM
End Date
10-4-2015 12:00 PM
Sponsor
Jarrett Amsden (Butler University)
Description
Background: Recent literature has demonstrated an increased incidence of acute kidney injury (AKI) with piperacillin-tazobactam and vancomycin when used in combination. The perceived increase in incidence of AKI in patients treated concomitantly with both antibiotics caused infectious disease physicians within the Community Health Network to avoid using the combination.
Study objective: To determine the incidence of AKI in patients treated with piperacillin-tazobactam and vancomycin.
Methods: This is a retrospective comparative chart review of patients admitted into Community Health Network hospitals between June 1, 2011 and June 30, 2013 and having received both vancomycin and piperacillin-tazobactam during their admission. Patients receiving this combination that developed AKI will be matched by date of admission ± 7 days to those who did not develop AKI, although still having received combination therapy. AKI will be defined as a ? 0.3mg/dL increase in SCr within 48 hours of therapy initiation of both antibiotics. The degree of AKI will be evaluated using the RIFLE criteria and determined based on their highest measured SCr value during admission. Resolution of AKI will be defined as return of kidney function (determined by SCr) back to baseline at time of discharge. Data collected will include ICU treatment, medication history, comorbidities, empiric therapy diagnosis, and 30-day readmissions. Additional data pertaining to the use of piperacillin-tazobactam and vancomycin, including days of therapy, dosing intervals, and vancomycin troughs and random levels will also be clinically evaluated. Comorbid conditions will be collected and compared using Charlson Comorbidity Index. Each patient's medication history will be assessed to identify potentially nephrotoxic medications prior to hospital admission, as well as those received during admission. This study was approved by the International Review Board on October 12, 2014.
Significance: According to a recent study as many as 50% of patients treated with the combination of piperacillin-tazobactam and vancomycin have developed acute kidney injury secondary to drug therapy. We hope that our study will help distinguish a patient population at risk, or drug characteristics that predispose patients to AKI. The identification of these characteristics will allow physicians to better determine the appropriate empiric antibiotic therapy for patients with possible risk factors in order to minimize the chance of developing AKI.
Retrospective Comparative Cohort of Concomitant Piperacillin-Tazobactam and Vancomycin Use and Acute Kidney Injury
Indianapolis, IN
Background: Recent literature has demonstrated an increased incidence of acute kidney injury (AKI) with piperacillin-tazobactam and vancomycin when used in combination. The perceived increase in incidence of AKI in patients treated concomitantly with both antibiotics caused infectious disease physicians within the Community Health Network to avoid using the combination.
Study objective: To determine the incidence of AKI in patients treated with piperacillin-tazobactam and vancomycin.
Methods: This is a retrospective comparative chart review of patients admitted into Community Health Network hospitals between June 1, 2011 and June 30, 2013 and having received both vancomycin and piperacillin-tazobactam during their admission. Patients receiving this combination that developed AKI will be matched by date of admission ± 7 days to those who did not develop AKI, although still having received combination therapy. AKI will be defined as a ? 0.3mg/dL increase in SCr within 48 hours of therapy initiation of both antibiotics. The degree of AKI will be evaluated using the RIFLE criteria and determined based on their highest measured SCr value during admission. Resolution of AKI will be defined as return of kidney function (determined by SCr) back to baseline at time of discharge. Data collected will include ICU treatment, medication history, comorbidities, empiric therapy diagnosis, and 30-day readmissions. Additional data pertaining to the use of piperacillin-tazobactam and vancomycin, including days of therapy, dosing intervals, and vancomycin troughs and random levels will also be clinically evaluated. Comorbid conditions will be collected and compared using Charlson Comorbidity Index. Each patient's medication history will be assessed to identify potentially nephrotoxic medications prior to hospital admission, as well as those received during admission. This study was approved by the International Review Board on October 12, 2014.
Significance: According to a recent study as many as 50% of patients treated with the combination of piperacillin-tazobactam and vancomycin have developed acute kidney injury secondary to drug therapy. We hope that our study will help distinguish a patient population at risk, or drug characteristics that predispose patients to AKI. The identification of these characteristics will allow physicians to better determine the appropriate empiric antibiotic therapy for patients with possible risk factors in order to minimize the chance of developing AKI.