A Large-Scale Multicenter Retrospective Study on Nephrotoxicity Associated With Empiric Broad-Spectrum Antibiotics in Critically Ill Patients
What is the most common empiric broad-spectrum antibiotic regimen you prescribe in the ICU?
0%Vancomycin + meropenem
0%Vancomycin + cefepime
0%Vancomycin + piperacillin/tazobactam
In this retrospective cohort study, researchers investigated the association between commonly prescribed empiric antibiotics on ICU admission and the risk of acute kidney injury (AKI). The study included 35,654 patients who received either vancomycin and piperacillin-tazobactam, vancomycin and cefepime, or vancomycin and meropenem exclusively. AKI was defined based on the Kidney Disease: Improving Global Outcomes stage 2 or 3 criteria using serum creatinine levels.
The results indicated that vancomycin and piperacillin-tazobactam were associated with a higher risk of AKI and initiation of dialysis compared to both vancomycin and cefepime and vancomycin and meropenem. The odds of AKI were particularly significant in patients without renal insufficiency who received a longer duration of vancomycin and piperacillin-tazobactam therapy compared to vancomycin and meropenem therapy.
Based on these findings, clinicians should be cautious when prescribing vancomycin and piperacillin-tazobactam to ICU patients, especially those with normal initial kidney function requiring longer treatment durations. Considering vancomycin and meropenem or vancomycin and cefepime as alternatives may help reduce the risk of nephrotoxicity in ICU patients.
#AcuteKidneyInjury #ICU #Vancomycin #PiperacillinTazobactam