Concerning nephrotoxicity of Top Guns: Concomitant Piperacillin/Tazobactam and Vancomycin with Vancomycin alone during treatment of critically ill patients

Objectives: Use of combination antibiotics piperacillin-tazobactam (PTZ) and Vancomycin (VAN) is so often used as ‘top guns’ for severe infections in hospitalized patients. VAN's nephrotoxicity is well-known. PTZ has been seen to prolong increased creatinine levels. Reports have surfaced in the literature of higher observed rates of acute kidney injury (AKI) among patients treated with combination of PTZ+VAN. The purpose of this study was to compare the prevalence of AKI with the use of VAN alone and combination of PTZ+VAN treatment at our institution. Our hypothesis was that the combination of PTZ+VAN will have higher prevalence of AKI as compared to VAN only.
Material and Methods: We performed study to compare the combination of PTZ+VAN and VAN alone in critically ill patients in our hospital from 2016 to 2018. Included patients were stratified by treatment with PTZ+VAN and VAN alone.
Results: A total of 113 patients were taken who were treated with PTZ+VAN and VAN alone. Patient demographics, comorbidities, sites of infection, and duration for 48 hours were compared. We found that PTZ+VAN is better than VAN alone.
Conclusion: The combination of vancomycin plus piperacillin-tazobactam is better use to prevent acute kidney injury over vancomycin monotherapy. Further research in the critically ill population is needed.