TY - JOUR
T1 - Impact of piperacillin/tazobactam on nephrotoxicity in patients with Gram-negative bacteraemia
AU - Hall, Ronald G.
AU - Yoo, Eunice
AU - Faust, Andrew
AU - Smith, Terri
AU - Goodman, Edward
AU - Mortensen, Eric M.
AU - Raza, Jaffar
AU - Dehmami, Farbod
AU - Alvarez, Carlos A.
N1 - Funding Information:
RGH has participated on an advisory board for Genentech and has received grant funding from Merck. All other authors declare no competing interests.
Publisher Copyright:
© 2019 Elsevier Ltd
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/3
Y1 - 2019/3
N2 - Piperacillin/tazobactam (TZP) has been associated with nephrotoxicity in patients receiving vancomycin. Its impact on nephrotoxicity in patients with Gram-negative bacteraemia (GNB) is unclear. This study evaluated the impact of TZP on nephrotoxicity in patients with GNB. This retrospective cohort included patients aged ≥18 years receiving ≥48 h of therapy for bacteraemia due to Escherichia coli, Pseudomonas aeruginosa, Enterobacter, Klebsiella, Acinetobacter or Stenotrophomonas maltophilia from 1/01/2008–8/31/2011. Patients with baseline serum creatinine (SCr) ≥3.5 mg/dL, polymicrobial infection or recurrent bacteraemia were excluded. Nephrotoxicity was defined as a ≥0.5 mg/dL increase in SCr or ≥50% increase from baseline for ≥2 consecutive days. Any variable demonstrating a 10% change in exposure effect was retained in the final model. All variables biologically reasonable causes of nephrotoxicity were also considered for inclusion. The median age of the cohort (n = 292) was 76 years; 38.0% had a cancer diagnosis and ICU residence was common (21.9%). There was no difference in nephrotoxicity incidence based on days of TZP received (0 days, 13.6%; 1–2 days, 14.7%; 3–4 days, 6.9%; ≥5 days, 16.7%; P = 0.71). In multivariable analysis, baseline SCr, total body weight and vasopressor use were independently associated with nephrotoxicity. Duration of TZP was not associated with nephrotoxicity in multivariable analysis (1–2 days, OR = 0.91, 95% CI 0.39–2.12; 3–4 days, OR = 0.48, 95% CI 0.10–2.46; ≥5 days, OR = 0.57, 95% CI 0.11–3.02). In this cohort of GNB patients, duration of TZP was not associated with nephrotoxicity.
AB - Piperacillin/tazobactam (TZP) has been associated with nephrotoxicity in patients receiving vancomycin. Its impact on nephrotoxicity in patients with Gram-negative bacteraemia (GNB) is unclear. This study evaluated the impact of TZP on nephrotoxicity in patients with GNB. This retrospective cohort included patients aged ≥18 years receiving ≥48 h of therapy for bacteraemia due to Escherichia coli, Pseudomonas aeruginosa, Enterobacter, Klebsiella, Acinetobacter or Stenotrophomonas maltophilia from 1/01/2008–8/31/2011. Patients with baseline serum creatinine (SCr) ≥3.5 mg/dL, polymicrobial infection or recurrent bacteraemia were excluded. Nephrotoxicity was defined as a ≥0.5 mg/dL increase in SCr or ≥50% increase from baseline for ≥2 consecutive days. Any variable demonstrating a 10% change in exposure effect was retained in the final model. All variables biologically reasonable causes of nephrotoxicity were also considered for inclusion. The median age of the cohort (n = 292) was 76 years; 38.0% had a cancer diagnosis and ICU residence was common (21.9%). There was no difference in nephrotoxicity incidence based on days of TZP received (0 days, 13.6%; 1–2 days, 14.7%; 3–4 days, 6.9%; ≥5 days, 16.7%; P = 0.71). In multivariable analysis, baseline SCr, total body weight and vasopressor use were independently associated with nephrotoxicity. Duration of TZP was not associated with nephrotoxicity in multivariable analysis (1–2 days, OR = 0.91, 95% CI 0.39–2.12; 3–4 days, OR = 0.48, 95% CI 0.10–2.46; ≥5 days, OR = 0.57, 95% CI 0.11–3.02). In this cohort of GNB patients, duration of TZP was not associated with nephrotoxicity.
KW - Acute kidney injury
KW - Gram-negative bacteraemia
KW - Nephrotoxicity
KW - Piperacillin/tazobactam
UR - http://www.scopus.com/inward/record.url?scp=85060757442&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060757442&partnerID=8YFLogxK
U2 - 10.1016/j.ijantimicag.2018.11.002
DO - 10.1016/j.ijantimicag.2018.11.002
M3 - Article
C2 - 30415001
AN - SCOPUS:85060757442
SN - 0924-8579
VL - 53
SP - 343
EP - 346
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
IS - 3
ER -