Impact of piperacillin/tazobactam on nephrotoxicity in patients with Gram-negative bacteraemia

Ronald G. Hall, Eunice Yoo, Andrew Faust, Terri Smith, Edward Goodman, Eric M. Mortensen, Jaffar Raza, Farbod Dehmami, Carlos A. Alvarez

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)343-346
Number of pages4
JournalInternational Journal of Antimicrobial Agents
Volume53
Issue number3
DOIs
StatePublished - Mar 2019

Keywords

  • Acute kidney injury
  • Gram-negative bacteraemia
  • Nephrotoxicity
  • Piperacillin/tazobactam

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

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