Objectives:

Evaluate the incidence of acute renal injury in patients receiving concomitant treatment with vancomycin and piperacillin/tazobactam, compared to groups of patients treated with both antibiotics alone or with vancomycin associated to meropenem.

Methods:

Were defined 4 study groups consisting of patients submitted to the following antibiotic treatment regimens in the last 2 years: one group concomitantly treated with vancomycin and piperacillin/tazobactam; a group treated only with piperacillin/tazobactam; a group of patients treated with vancomycin alone; a group treated with vancomycin and meropenem in combination.

For each patient in the study groups, serum creatinine values were analyzed immediately prior to the start of each treatment and after the end of treatment.

A database was elaborated in which patient identification, age, start and end date of treatment, initial and final serum creatinine values as respective diferences, were established.

Patients were selected according to the following eligibility criteria: treatment duration greater than 72 hours and with available serum creatinine values immediately before and after treatment.

This study uses the KDIGO classification, which defines acute kidney injury when one of the following criteria is found:

- Increased serum creatinine greater than or equal to 0.3 mg/dL within 48 hours;

- Increased serum creatinine greater than or equal to 1.5x the reference value, which is known or presumed to have occurred within one week;

- Urine output less than 0.5 ml/kg/hr for more than 6 consecutive hours.

Findings:

The results obtained for the analyzed samples indicate that 30.8% of the patients treated with the combination vancomycin+piperacillin/tazobactam developed acute renal injury, whereas the sample with a single treatment with piperacillin/tazobactam presented 12% of cases and the vancomycin groups alone and vancomycin plus meropenem showed both an incidence of 7.1%.

Discussion/conclusions:

The results obtained, confirm the tendency to increase the incidence of acute renal injury in patients submitted to concomitant treatment with vancomycin and piperacillin/ tazobactam compared to patients treated with vancomycin or piperacillin/tazobactam alone, or with the association vancomycin+meropenem.

Although the association between acute renal injury and concomitant treatment with vancomycin and piperacillin/tazobactam is known and has been the target of several recent studies in some countries, a research work in this field has not yet been developed in Portugal, especially when it is a therapeutic option often considered in national hospitals.

In the context of empiric antibiotic therapy, whenever possible, the combination of vancomycin+piperacillin/tazobactam should be avoided and replaced by other safer alternatives, particularly in patients with impaired renal function or treated concomitantly with potentially nephrotoxic drugs.

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