Acute Kidney Injury with Vancomycin, Antipseudomonal Combination Therapy

Investigators assessed the incidence of acute kidney injury in patients requiring vancomycin and antipseudomonal agents, particularly comparing piperacillin-tazobactam vs cefepime in combination with vancomycin.

Combination therapy with vancomycin and piperacillin-tazobactam (VPT) was associated with increased incidence of acute kidney injury (AKI) compared with vancomycin and cefepime therapy (VC), according to data presented at IDWeek, held virtually from October 21 to 25, 2020.

It is unclear if combinations with certain antipseudomonal agents are associated with more AKI relative to others. Investigators at 2 Veteran Affairs (VA) medical centers conducted a retrospective cohort study comparing VPT and VC therapies, which are both preferred empiric vancomycin-antipseudomonal regimens.

There were 120 patients in both VPT and VC groups. In the VPT group, 17.5% of patients (21/120) developed AKI, compared to 3.3% of patients (4/120) in the VC group (P =.0005). Incidence of AKI remained significantly higher in the VPT group after propensity score matching (15.2% vs 4.0%; P =.01). Median length of stay was significantly longer for VPT patients (10 days vs 8 days; P =.03) but there were no differences in 90-day mortality, incidence of Clostridioides (Clostridium) difficile infection, development of chronic kidney disease within 90 days, or the requirement of hemodialysis within 1 year.

Limitations of the study include its retrospective nature, its primary population was older men, and exclusion of patients with renal insufficiency.

“Nephrotoxicity is significantly greater with combination vancomycin and piperacillin-tazobactam compared to vancomycin and cefepime,” investigators concluded. They recommend that decisions to use these combination therapies be done alongside evaluations of other AKI risk factors and with close monitoring.


Wang N, Jetsupphasuk K, Nguyen PK, et al. Acute kidney injury with piperacillin-tazobactam versus cefepime in combination with vancomycin. Presented at: IDWeek 2020; October 21-25, 2020. Poster 212.