Incidence Evaluation of Acute Kidney Injury and Pharmacoeconomic Analysis Among Critically Ill Patients With Use of Antipseudomonal β-Lactams and Vancomycin

Abstract

\n Background: Whether vancomycin (VAN) plus piperacillin-tazobactam (PTZ) could increase the risk of acute kidney injury (AKI) is still controversial in critically ill patients. The purpose of this study was to compare the risk of developing AKI and risk of developing AKI and treatment cost among this population receiving VAN/PTZ to a matched group receiving VAN/other antipseudomonal β-lactams. Methods: This multicenter, retrospective, matched study included 700 critically ill patients who received ≥48 hours of VAN/PTZ or VAN/other antipseudomonal β-lactams. The risk of developing AKI was compared between these two combination therapies using propensity-adjusted analysis. Furthermore, a pharmacoeconomic decision-analytic model was performed.Results: According to three AKI-defined criteria, VAN/PTZ was associated with significantly higher incidence of than VAN/other antipseudomonal β-lactams (all P < 0.001). In multivariate analysis, regardless of any VAN/other antipseudomonal β-lactams, VAN/PTZ was an independent predictor for stage 2 or 3 AKI. In the empiric treatment, the incremental cost-effectiveness ratios per additional nephrotoxic episode of 1147.35$, 1845.11$, and 3989.95$ were found for VAN/PTZ relative to, vancomycin plus imipenem-cilastatin, vancomycin plus meropenem, and vancomycin plus cefoperazone-sulbactam, respectively. Conclusion: In critically ill patients, VAN/PTZ was associated with both higher AKI risk and treatment cost when considering AKI occurence compared to VAN/other antipseudomonal β-lactams.Trial registration: retrospectively registered, ClinicalTrials.gov number: NCT03776409.