Acute Kidney Injury in Hematopoietic Cell Transplantation Patients Receiving Vancomycin and Piperacillin/Tazobactam Versus Vancomycin and Cefepime

Amber B. Clemmons, Christine F. Bech, Jeremy Mark Pantin, Imran Ahmad

Research output: Contribution to journalArticle

Abstract

Empiric antimicrobials are frequently utilized in the pre-engraftment phase after hematopoietic cell transplantation (HCT). Recent evidence suggests an increased risk of acute kidney injury (AKI) from combination of vancomycin with piperacillin/tazobactam; however, this has not specifically been evaluated in the HCT population. A single-center, retrospective review was conducted from 2011 to 2017 on 110 autologous and 60 allogeneic HCT patients with the primary objective of comparing incidence of AKI for those who received vancomycin with piperacillin/tazobactam versus vancomycin with cefepime in the pre-engraftment phase. Demographics and outcomes were compared for all patients who received vancomycin with piperacillin/tazobactam versus vancomycin with cefepime as well as within the autologous and allogeneic subgroups. The primary endpoint of incidence of AKI, defined as increase in serum creatinine by.3 mg/dL or >50% from baseline (whichever was larger), was significantly higher for those who received vancomycin with piperacillin/tazobactam versus cefepime for the overall cohort (68% versus 27%; P <.001) resulting in an odds ratio (OR) of 5.16 (95% confidence interval [CI], 2.5 to 10.5) when adjusting for hypotension. Results were similar within the autologous (59% versus 22%; P <.001; OR, 4.63; 95% CI, 1.85 to 11.6) and allogeneic (79% versus 39%; P =.0021; OR, 5.41; 95% CI, 1.60 to 18.3) subgroups. Within the overall cohort between those who received vancomycin with piperacillin/tazobactam versus cefepime the time to onset of AKI was more commonly within 48 hours of concomitant antimicrobial use (53% versus 26%; P =.012), whereas resolution of AKI by discharge date was not different (39% versus 26%; P =.23). No difference in percentage of patients requiring at least 1 session of dialysis, duration of hospital stay, or 30-day mortality was found between overall cohorts. Further studies of HCT patients are warranted to fully elucidate the risk of various combination antimicrobial regimens on renal outcomes.

LanguageEnglish (US)
Pages820-826
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Cell Transplantation
Vancomycin
Acute Kidney Injury
Odds Ratio
Confidence Intervals
Incidence
tazobactam drug combination piperacillin
cefepime
Hypotension
Dialysis
Length of Stay
Creatinine
Demography
Kidney
Mortality
Serum
Population

Keywords

  • Acute kidney injury
  • Antimicrobial
  • Cefepime
  • Hematopoietic cell transplantation
  • Piperacillin/tazobactam
  • Vancomycin

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Acute Kidney Injury in Hematopoietic Cell Transplantation Patients Receiving Vancomycin and Piperacillin/Tazobactam Versus Vancomycin and Cefepime. / Clemmons, Amber B.; Bech, Christine F.; Pantin, Jeremy Mark; Ahmad, Imran.

In: Biology of Blood and Marrow Transplantation, Vol. 24, No. 4, 01.04.2018, p. 820-826.

Research output: Contribution to journalArticle

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