Frequency of Acute Kidney Injury in Patient Receiving Piperacillin - Tazobactam: A Hospital-based Study from Qatar
Abstract
Background: several studies have been reported piperacillin-tazobactam (TAZ / PIPC)-associated AKI with various frequencies. The aim of this study was to determine the frequency of TAZ/PIPC- associated AKI among our patients and to identify the risk factors for this clinical entity. Methods: this retrospective cross-sectional study was conducted at Hamad General Hospital; it involved adult patients who were admitted from January 2017 to December 2017. Results: we involved 917 patients, of whom 635 (69.25%) were males and 282 (30.75%) were females. The mean age of the patients was 52 (SD 19) years, and 98 (10.7%) patients were diagnosed with AKI. The patients with AKI were significantly older than without AKI [59.71 (SD 19.79) versus 51.06 (SD 18.67); P <0.001]. After TAZ/PIPC initiation, the mean creatinine level in the AKI group was higher than the mean creatinine level in the non-AKI group, [158.91 (SD 81.93) versus 66.78 (SD 21.42); P<001]. The mean time of onset of AKI after PIPC/TAZ initiation was 4.46 (SD 3.20) (1-12 days). AKI was significantly associated with low mean serum albumin (P<0.001), high mean fasting blood glucose (P<0.001), coronary artery diseases (P<0.001), heart failure (P<0.001), liver diseases (P=0.047), diabetes mellitus (P=0.021) and hypertension (P<0.001). The in-hospital mortality was significantly higher in the AKI group [38.78% versus 5.13% in the non-AKI group; P<0.001], and only advanced age and heart failure were found as independent risk factors for TAZ/PIPC-associated AKI. Conclusion: TAZ/PIPC was significantly associated with AKI. Advanced age and heart failure were identified as independent risk factors for TAZ/PIPC-associated AKI.
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References
Khan FY, Elhiday A, Khudair IF, et al. Evaluation of the use of piperacillin/tazobactam (Tazocin) at Hamad General Hospital, Qatar: are there unjustified prescriptions? Infect Drug Resist. 2012;5:17-21.
Khan FY, Abu-Khattab M, Anand D, et al. Epidemiological features of Clostridium difficile infection among inpatients at Hamad General Hospital in the state of Qatar, 2006-2009. Travel Med Infect Dis. 2012;10(4):179-85.
Karino S, Kaye KS, Navalkele B, et al. Epidemiology of acute kidney injury among patients receiving concomitant Vancomycin and Piperacillin-Tazobactam: Opportunities for antimicrobial stewardship. Antimicrob Agents Chemother. 2016;60(6):3743–50.
Rutter WC, Burgess DR, Talbert JC, Burgess DS. Acute kidney injury in patients treated with vancomycin and piperacillin-tazobactam: A retrospective cohort analysis. J Hosp Med. 2017;12(2):77–82. doi:10.12788/jhm.2684.
Morimoto T, Nagashima H, Morimoto Y, Tokuyama S. Frequency of acute kidney injury caused by Tazobactam/Piperacillin in patients with pneumonia and chronic kidney disease: A retrospective observational study. Yakugaku Zasshi. 2017;137(9):1129-36.
Kidney International Supplements. Kidney disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guideline for acute kidney injury. http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf. Published March 2012. Accessed July 11, 2019.
McCormick H, Tomaka N, Baggett S, et al. Comparison of acute renal injury associated with intermittent and extended infusion piperacillin/tazobactam. Am J Health Syst Pharm. American Society of Health-System Pharmacists; 2015;72 (11 Suppl 1):S25–30.
Kadomura S, Takekuma Y, Sato Y, Sumi M, Kawamoto K, Itoh T, Sugawara M. Higher incidence of acute kidney injury in patients treated with piperacillin/tazobactam than in patients treated with cefepime: a single-center retrospective cohort study. J Pharm Health Care Sci. 2019;5:13.
Karino F, Miura K, Fuchita H, et al. Efficacy and safety of piperacillin/tazobactam versus biapenem in late elderly patients with nursing- and healthcare-associated pneumonia. J Infect Chemother. 2013;19(5):909–15.
Carreno J, Smiraglia T, Hunter C, Tobin E, Lomaestro B. Comparative incidence and excess risk of acute kidney injury in hospitalised patients receiving vancomycin and piperacillin/tazobactam in combination or as monotherapy. Int J Antimicrob Agents. 2018;52(5):643-50.
Kim T, Kandiah S, Patel M, et al. Risk factors for kidney injury during vancomycin and piperacillin/tazobactam administration, including increased odds of injury with combination therapy. BMC Res Notes. 2015;8:579.
LeCleir LK, Pettit RS. Piperacillin-tazobactam versus cefepime incidence of acute kidney injury in combination with vancomycin and tobramycin in pediatric cystic fibrosis patients. Pediatr Pulmonol. 2017;52(8):1000-5.
Luther MK, Timbrook TT, Caffrey AR, Dosa D, Lodise TP, LaPlante KL. Vancomycin plus Piperacillin-Tazobactam and acute kidney injury in adults: A systematic review and meta-analysis. Crit Care Med. 2018;46(1):12-20.
Lorenz MA, Moenster RP, Linneman TW. Effect of piperacillin/tazobactam restriction on usage and rates of acute renal failure. J Med Microbiol. 2016;65(2):195-9.
Wang HE, Muntner P, Chertow GM, Warnock DG. Acute kidney injury and mortality in hospitalized patients. Am J Nephrol. 2012;35:349–55.
Jensen JU, Hein L, Lundg1. Khan FY, Elhiday A, Khudair IF, et al. Evaluation of the use of piperacillin/tazobactam (Tazocin) at Hamad General Hospital, Qatar: are there unjustified prescriptions? Infect Drug Resist. 2012;5:17-21.
Khan FY, Abu-Khattab M, Anand D, et al. Epidemiological features of Clostridium difficile infection among inpatients at Hamad General Hospital in the state of Qatar, 2006-2009. Travel Med Infect Dis. 2012;10(4):179-85.
Karino S, Kaye KS, Navalkele B, et al. Epidemiology of acute kidney injury among patients receiving concomitant Vancomycin and Piperacillin-Tazobactam: Opportunities for antimicrobial stewardship. Antimicrob Agents Chemother. 2016;60(6):3743–50.
Rutter WC, Burgess DR, Talbert JC, Burgess DS. Acute kidney injury in patients treated with vancomycin and piperacillin-tazobactam: A retrospective cohort analysis. J Hosp Med. 2017;12(2):77–82. doi:10.12788/jhm.2684.
Morimoto T, Nagashima H, Morimoto Y, Tokuyama S. Frequency of acute kidney injury caused by Tazobactam/Piperacillin in patients with pneumonia and chronic kidney disease: A retrospective observational study. Yakugaku Zasshi. 2017;137(9):1129-36.
Kidney International Supplements. Kidney disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guideline for acute kidney injury. http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf. Published March 2012. Accessed July 11, 2019.
McCormick H, Tomaka N, Baggett S, et al. Comparison of acute renal injury associated with intermittent and extended infusion piperacillin/tazobactam. Am J Health Syst Pharm. American Society of Health-System Pharmacists; 2015;72 (11 Suppl 1):S25–30.
Kadomura S, Takekuma Y, Sato Y, Sumi M, Kawamoto K, Itoh T, Sugawara M. Higher incidence of acute kidney injury in patients treated with piperacillin/tazobactam than in patients treated with cefepime: a single-center retrospective cohort study. J Pharm Health Care Sci. 2019;5:13.
Karino F, Miura K, Fuchita H, et al. Efficacy and safety of piperacillin/tazobactam versus biapenem in late elderly patients with nursing- and healthcare-associated pneumonia. J Infect Chemother. 2013;19(5):909–15.
Carreno J, Smiraglia T, Hunter C, Tobin E, Lomaestro B. Comparative incidence and excess risk of acute kidney injury in hospitalised patients receiving vancomycin and piperacillin/tazobactam in combination or as monotherapy. Int J Antimicrob Agents. 2018;52(5):643-50.
Kim T, Kandiah S, Patel M, et al. Risk factors for kidney injury during vancomycin and piperacillin/tazobactam administration, including increased odds of injury with combination therapy. BMC Res Notes. 2015;8:579.
LeCleir LK, Pettit RS. Piperacillin-tazobactam versus cefepime incidence of acute kidney injury in combination with vancomycin and tobramycin in pediatric cystic fibrosis patients. Pediatr Pulmonol. 2017;52(8):1000-5.
Luther MK, Timbrook TT, Caffrey AR, Dosa D, Lodise TP, LaPlante KL. Vancomycin plus Piperacillin-Tazobactam and acute kidney injury in adults: A systematic review and meta-analysis. Crit Care Med. 2018;46(1):12-20.
Lorenz MA, Moenster RP, Linneman TW. Effect of piperacillin/tazobactam restriction on usage and rates of acute renal failure. J Med Microbiol. 2016;65(2):195-9.
Wang HE, Muntner P, Chertow GM, Warnock DG. Acute kidney injury and mortality in hospitalized patients. Am J Nephrol. 2012;35:349–55.
Jensen JU, Hein L, Lundgren B, et al. Procalcitonin and Survival Study (PASS) Group. Kidney failure related to broad-spectrum antibiotics in critically ill patients: secondary end point results from a 1200 patient randomised trial. BMJ Open. 2012;2:e000635.
Watkins RR, Deresinski S. Increasing evidence of the nephrotoxicity of Piperacillin/Tazobactam and Vancomycin combination therapy: What is the clinician to do? Clin Infect Dis. 2017;65(12):2137-43.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365-70.
ren B, et al. Procalcitonin and Survival Study (PASS) Group. Kidney failure related to broad-spectrum antibiotics in critically ill patients: secondary end point results from a 1200 patient randomised trial. BMJ Open. 2012;2:e000635.
Watkins RR, Deresinski S. Increasing evidence of the nephrotoxicity of Piperacillin/Tazobactam and Vancomycin combination therapy: What is the clinician to do? Clin Infect Dis. 2017;65(12):2137-43.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365-70.
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