AI Article Synopsis

  • Vancomycin plus piperacillin-tazobactam (VPT) is a common treatment for septic patients, but it is generally believed to be more harmful to the kidneys than vancomycin plus cefepime (VC) over extended use.
  • A study was conducted on 418 septic patients, comparing those treated with VPT versus those treated with VC, focusing on acute kidney injury (AKI) rates and renal recovery within 72 hours of treatment.
  • Results showed similar rates of AKI between the two groups, suggesting that initial treatment with VPT may not significantly increase kidney damage risk, especially when therapy is adjusted based on clinical findings.

Article Abstract

Vancomycin plus piperacillin-tazobactam (VPT) is a commonly used antimicrobial regimen for septic patients. VPT is more nephrotoxic than other regimens such as vancomycin plus cefepime (VC) when given over several days. This risk of nephrotoxicity is less clear when VPT is given for initial empiric therapy in sepsis and de-escalated quickly based on evolving clinical information. The objective of this study was to assess nephrotoxicity among septic patients empirically treated with either VPT or VC at initial clinical presentation. We conducted a retrospective study of septic patients who received VPT or VC within 12 h of presentation to the emergency department. The primary outcomes were acute kidney injury (AKI) and renal recovery 72 h after presentation. For the total of 418 patients, 306 received VPT and 112 received VC. Rates of AKI at 72 h were 15.2% for VPT patients and 11.0% for VC patients [p = 0.44]. Among patients with AKI at presentation, 16.3% of VPT patients had AKI at 72 h compared to 8.9% of VC patients [p = 0.19]. Among those without AKI at presentation, 14.2% VPT patients and 16.7% VC patients had AKI at 72 h [p = 0.71]. Renal recovery rates for patients with AKI at presentation were 42.3% for VPT patients versus 40.3% for VC patients [p = 0.78]. In-hospital renal replacement therapy occurred in 6.2% VPT patients and 0.9% VC patients [p = 0.024]. Therefore, initial empiric therapy with VPT in sepsis may not confer increased risk of AKI when de-escalated appropriately.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178657PMC
http://dx.doi.org/10.1007/s11739-021-02772-2DOI Listing

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