Antibiotic Combination Increases AKI Risk in Hospitalized Children

Co-administration of intravenous (IV) vancomycin with piperacillin sodium/tazobactam sodium increases the risk for acute kidney injury (AKI) in children, according to the findings of a recent study.

While the combination of IV vancomycin with piperacillin/tazobactam is associated with a higher risk for AKI in adults, few studies have examined the safety of this combined treatment or another β-lactam antibiotic in children.
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To perform their retrospective cohort study, the researchers analyzed the data from 6 pediatric hospitals using the Pediatric Health Information System Plus database. Their analysis included 1915 children who were hospitalized for 3 or more days and received IV vancomycin and 1 other antipseudomonal β-lactam combination therapy from January 1, 2007, through December 31, 2012. The median age of patients was 5.6 years, and 1049 patients were male (54.%).

The researchers assessed the incidence of AKI within 2 days of receiving antibiotic combination therapy. In addition, they used logistic regression to test the association between receiving combination therapy and the odds of developing AKI.

Antibiotic-associated AKI was observed in 157 patients (8.2%) who received IV vancomycin with 1 other antipseudomonal β-lactam antibiotic, which includes 117 patients (11.7%) out of 1009 patients who received IV vancomycin with piperacillin/tazobactam.

IV vancomycin and piperacillin/tazobactam combination therapy was associated with greater odds of developing AKI for each hospital day compared with vancomycin and 1 other antipseudomonal β-lactam antibiotic combination after researchers adjusted for age, intensive care unit level of care, receipt of nephrotoxins, and hospital. 

“Coadministration of IV vancomycin and piperacillin/tazobactam may increase the risk of AKI in hospitalized children,” the researchers concluded. “Pediatricians must be cognizant of the potential added risk of this combination therapy when making empirical antibiotic choices.”

—Melissa Weiss

Reference:

Downes KJ, Cowden C, Laskin BL, et al. Association of acute kidney injury with concomitant vancomycin and piperacillin/tazobactam treatment among hospitalized children [published online October 2, 2017]. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.3219.