Piperacillin/tazobactam and risk of acute kidney injury in adults hospitalized with infection without vancomycin: a multi-centre real-world data analysis |
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| Affiliation: | 1. National Clinical Research Centre for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Centre for Kidney Disease, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China;2. Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China;3. Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden;4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;5. Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;6. Department of Nephrology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China;7. Department of Nephrology, Sir Run Shaw Hospital affiliated to Zhejiang University School of Medicine, Zhejiang, Hangzhou, China;8. Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, China;9. Department of Nephrology, Shenzhen Second People''s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China;10. Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China;11. Children''s Hospital of Fudan University, China;12. Renal Department and Institute of Nephrology, Sichuan Provincial People''s Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, China;13. Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China;14. Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China;15. Department of Critical Care Medicine, Maoming People''s Hospital, Guangdong Province, China;p. Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Guangdong, China;q. Huizhou Municipal Central Hospital, Guangdong, China;r. Guizhou Provincial People''s Hospital, Guiyang, China;s. Foshan First People''s Hospital, Guangdong, China;t. The Third Affiliated Hospital of Southern Medical University, China;u. Shunde Hospital, Southern Medical University, The First People''s Hospital of Shunde, Guangdong, China;v. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia;w. Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia;1. Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, California, USA;2. National Regional Reference Laboratory for Antimicrobial Resistance (NRL), Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina;3. INVERA- Investigación en Resistencia a los Antimicrobianos, Asociación Civil, Buenos Aires, Argentina;4. Research Service and GRECC, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA;5. Departments of Medicine, Pharmacology, Molecular Biology and Microbiology, Biochemistry, Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA;6. CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA;1. Department of Pharmacy, Washington Regional Medical Center, Fayetteville, AR, USA;2. College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA;3. Department of Mathematical Sciences, University of Arkansas, Fayetteville, AR, USA;4. Clinical Research Departments of Surgery and Radiology, University of Arkansas for Medical Sciences Northwest Regional Campus, Fayetteville, AR, USA;5. Department of Antimicrobial Stewardship, Washington Regional Medical Center, Fayetteville, AR, USA;1. UMR 1173, Versailles Saint-Quentin University, Versailles, France;2. Raymond Poincaré Paris Saclay University Hospital, Garches, France;3. FHU PROTHEE, St Louis Hospital, Paris-Cité University, Paris, France;4. CIC, Raymond Poincaré Paris Saclay University Hospital, Garches, France;5. Microbiology Unit, Raymond Poincaré Paris Saclay University Hospital, Garches, France;6. Toxicology Unit, Bichat Paris Nord University Hospital, Paris, France;7. Institut for Infectious Agents, Department of Bacteriology - CNR des staphylocoques, Croix-Rousse Hospital, North Biology Centre, Hospices Civils de Lyon, Lyon, France;8. Team “Staphylococcal pathogenesis”, International Centre for Infectiology Research, INSERM U1111 - CNRS UMR5308 - ENS Lyon - Lyon 1 University, Lyon, France;1. Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, Singapore;2. Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore;3. Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore, Singapore;4. Singhealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore;5. Singhealth Duke-NUS Pathology Academic Clinical Programme, Singapore, Singapore;1. Laboratoire de Bactériologie, Département de Biologie des Agents Infectieux, CHU Angers, Angers, France;2. Service des Maladies Infectieuses et Tropicales, CHU Angers, Angers, France;3. Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, INCIT, Angers, France;1. Department of Clinical Pharmacy, OLVG, Amsterdam, the Netherlands;2. Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;3. Department of Pharmacy, Centre of Expertise in Mycology Radboudumc/CWZ and Radboud Institute of Health Science, University of Nijmegen, Radboudumc Nijmegen, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands;4. Department of Haematology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;5. Department of Haematology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands;6. Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands;7. Department of Mathematics and Computer Science, Eindhoven University of Technology, 5612 AZ, Eindhoven, the Netherlands;8. Department of Haematology, Meander Medical Centre Amersfoort, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands;9. Department of Oncology and Haematology, Oldenburg Clinic, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany;10. Department of Haematology, University Medical Centre Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherland;11. Department of Radiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;12. Department of Internal Medicine and Infectious Diseases, Erasmus University Medical Centre, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands;13. Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands;14. Department of Medical Microbiology, Radboudumc Nijmegen, the Netherlands; Centre of Expertise in Mycology Radboudumc/CWZ, Radboud University, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands;15. Department of Haematology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands;p. Department of Haematology, Haga Hospital, Els Borst-Eilersplein 275, 2545 AA, The Hague, the Netherlands;q. Department of Haematology, Radboudumc Nijmegen, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands; Radboud Institute of Health Sciences, Geert Grooteplein Zuid 21, 6525 EZ, Nijmegen, the Netherlands;r. Groningen Research Institute of Pharmacy, Pharmacotherapy, Epidemiology & Economics, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;s. Department of Internal Medicine and Department of Pulmonary Diseases and Tuberculosis Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;t. Faculty of Medicine and Health, Sydney Pharmacy School, University of Sydney, Camperdown NSW 2006, Sydney, Australia;u. Westmead Hospital, Westmead, Sydney, NSW 2145, Australia |
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| Abstract: | BackgroundThere is uncertainty about whether piperacillin/tazobactam (PT) increases the risk of acute kidney injury (AKI) in patients without concomitant use of vancomycin. This study compared the risk of hospital-acquired AKI (HA-AKI) among adults treated with PT or antipseudomonal β-lactams (meropenem, ceftazidime) without concomitant use of vancomycin.MethodsThis real-world study analysed the data from China Renal Data System and assessed the risk of HA-AKI in adults hospitalized with infection after exposure to PT, meropenem or ceftazidime in the absence of concomitant vancomycin. The primary outcome was any stage of HA-AKI according to the Kidney Disease Improving Global Outcomes guidelines. A multi-variable Cox regression model and different propensity score (PS) matching models were used.ResultsAmong the 29,441 adults mean (standard deviation) age 62.44 (16.84) years; 17,980 females (61.1%)] included in this study, 14,721 (50%) used PT, 9081 (31%) used meropenem and 5639 (19%) used ceftazidime. During a median follow-up period of 8 days, 2601 (8.8%) develped HA-AKI. The use of PT was not associated with significantly higher risk of HA-AKI compared with meropenem adjusted hazard ratio (aHR) 1.07, 95% confidence interval (CI) 0.97–1.19], ceftazidime (aHR 1.09, 95% CI 0.92–1.30) or both agents (aHR 1.07, 95% CI 0.97–1.17) after adjusting for confounders. Results were consistent in stratified analyses, PS matching using logistic regression or random forest methods to generate a PS, and in an analysis restricting outcomes to AKI stage 2–3.ConclusionsWithout concomitant use of vancomycin, the risk of AKI following PT therapy is comparable with that of meropenem or ceftazidime among adults hospitalized with infection. |
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