Nephrotoxicity from Vancomycin Combined with Piperacillin-Tazobactam: A Comprehensive Review

Am J Nephrol. 2021;52(2):85-97. doi: 10.1159/000513742. Epub 2021 Mar 18.

Abstract

Background: Recent studies have identified the combination of vancomycin with piperacillin-tazobactam (VPT) to be associated with increased nephrotoxicity. Multiple, large cohort studies have found this widely used combination to have a higher risk of nephrotoxicity than other regimens in a variety of populations.

Summary: This review summarizes the epidemiology and clinical features of VPT-associated acute kidney injury (AKI). Potential mechanisms involved in the pathogenesis of this phenomenon are also discussed. Key Message: VPT-associated nephrotoxicity is a recently recognized clinical entity. Clinical strategies to minimize the risk of toxicity in this setting include antimicrobial stewardship, monitoring of kidney function, and emerging data supporting the potential role for novel biomarkers in predicting and managing AKI.

Keywords: Acute kidney injury; Antimicrobial toxicity; Drug interaction; Drug toxicity; Piperacillin-tazobactam; Vancomycin.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / complications*
  • Acute Kidney Injury / epidemiology
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects*
  • Antimicrobial Stewardship
  • Creatinine / metabolism
  • Critical Illness
  • Drug Therapy, Combination / adverse effects
  • Humans
  • Kidney Tubules / metabolism
  • Nephritis / chemically induced
  • Nephritis / immunology
  • Patient Acuity
  • Piperacillin, Tazobactam Drug Combination / administration & dosage
  • Piperacillin, Tazobactam Drug Combination / adverse effects*
  • Risk Factors
  • Vancomycin / administration & dosage
  • Vancomycin / adverse effects*

Substances

  • Anti-Bacterial Agents
  • Piperacillin, Tazobactam Drug Combination
  • Vancomycin
  • Creatinine