Vol.72 No.6 November 2024

A multicenter study on the incidence of acute kidney injury according to the severity during combined therapy with vancomycin or teicoplanin and tazobactam/piperacillin

Takahiro Senzaki^{1, 2)}, Hiroyuki Uchida³⁾, Shusaku Noguchi¹⁾, Mana Sekiguchi³⁾, Miharu Nakajima³⁾, Toru Sakawagawa^{1, 2)}, Takahiro Narimiya⁵⁾, Akiko Mori⁵⁾, Kazuki Niwa⁴⁾, Kazuo Kobayashi⁵⁾, Yoshitomo Kawai³⁾, Eijo Kasahara¹⁾ and Minako Kobayashi²⁾

¹⁾Department of Pharmacy, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-machi, Nakahara-ku, Kawasaki, Kanagawa, Japan
²⁾Department of Infection Control, Nippon Medical School Musashikosugi Hospital
³⁾Department of Pharmacy, Kanto Rosai Hospital
⁴⁾Department of General Internal Medicine, Kanto Rosai Hospital
⁵⁾Department of Pharmacy, Kawasaki Municipal Hospital

Abstract

Combined tazobactam/piperacillin (TAZ/PIPC) plus vancomycin (VCM) therapy has been identified as a risk factor for acute kidney injury (AKI), and use of teicoplanin (TEIC) in place of VCM is reported as being associated with a significantly lower incidence of AKI. However, there are no reports on the incidence of AKI according to the severity in either patients receiving TAZ/PIPC+VCM or those receiving TAZ/PIPC+TEIC. Herein, we compared the incidence of AKI of various grades of severity in patients treated with TAZ/PIPC+VCM therapy (VCM group) and those treated with TAZ/PIPC+TEIC therapy (TEIC group). Patients aged ≥18 years old who were hospitalized in any of the three participating hospitals and received either of the two aforementioned antibiotic combinations for at least 48 hours were included in the study (VCM group, n=322; TEIC group, n=80); those meeting the exclusion criteria were excluded. Finally, 48 patients per group adjusted for background variables using propensity score matching were included in the analysis. The overall incidence of AKI in the TEIC group was 14.6% (7/48 patients), which was significantly lower than that of 35.4% (17/48 patients) in the VCM group (p=0.03). The severity of the AKI was classified into four categories according to the Sequential Organ Failure Assessment (SOFA) scores, as follows: 0-1, 2-7, 8-11, and ≥12. Then, the incidence of AKI of each grade of severity were evaluated in the two treatment groups. The incidence of AKI with a SOFA score of 0-1 in the TEIC group was significantly lower than that in the VCM group [6.2% (1/16 patients) versus 50.0% (8/16 patients); p=0.02]. However, the incidence of AKI with SOFA scores of ≥2 did not differ significantly between the two groups. Overall, the incidence of AKI was significantly lower in the TEIC group than in the VCM group. The severity of illness classification data suggest that in particular, the incidence of mild AKI (SOFA score <2) was significantly lower in the TEIC group as compared with the VCM group.

Key word

TAZ/PIPC, VCM, TEIC, acute kidney injury, severity of illness

Received

April 15, 2024

Accepted

July 22, 2024

Jpn. J. Chemother. 72 (6): 568-576, 2024