(C-245) Risk of Acute Kidney Injury with Concurrent Vancomycin and Piperacillin-Tazobactam Treatment in Hospitalized Patients with Community-Acquired Pneumonia Diagnosis

Tuesday, August 26, 2025

12:00 PM - 1:30 PM ET

Presenting Author(s)

Adeniyi J. Idigo, BPharm, PhD

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB) Alabama, United States

Co-Author(s)

JW

J. Michael Wells, MD, MSPH

Division of Pulmonary, Allergy, and Critical Care Medicine, UAB, Alabama, United States
MB

Matthew L. Brown

Department of Pharmacy, UAB Hospital, United States
HW

Howard W. Wiener

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB) Alabama, United States
PS

Paul W. Sanders

Division of Nephrology, UAB School of Medicine Alabama, United States
RG

Russell L. Griffin

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB) Alabama, United States
GC

Gary Cutter

Department of Biostatistics, School of Public Health, UAB, United States
RL

Rachael A. Lee

Department of Medicine, Division of Infectious Diseases, UAB School of Medicine Alabama, United States
SS

Sadeep Shrestha

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB) Alabama, United States

Background: Vancomycin (V) has a known risk for acute kidney injury (AKI) with additive AKI risk in combination with piperacillin-tazobactam (PT), (V-PT). Little is known about AKI risk in community-acquired pneumonia (CAP) treated with V-PT.

Objectives: To compare AKI risks of V-PT with 1) ceftriaxone and 2) vancomycin-cefepime (V-C) in hospitalized CAP patients.

Methods: We performed a retrospective cohort study to examine the changes in serum creatinine of patients with a diagnosis code for CAP who were treated with V-PT, V-C, or ceftriaxone. Log binomial regression models were used to examine associations of antibiotics treatments with AKI, adjusting for initial serum creatinine and other potential confounders.

Results: Of 1,155 CAP patients, 243 (21%) had medical intensive care unit admission (MICU), 197 (17%) developed AKI, and 123 (11%) died during hospitalization. AKI patients had longer length of hospital stay (22 days vs 10 days; p < 0.0001) and higher MICU admission (62[32%] vs 181[19%], p< 0.0001) and deaths (52[26%] vs 71[7%], p< 0.0001) when compared to those who did not have AKI. Of all patients, 61% were concurrently treated with V-PT (699) and 15% treated with V-C (173), 19% (224) treated with V or PT, and only 5% (59) were treated with ceftriaxone without V or PT. Those treated with V-PT had higher MICU admissions (182[26%] vs 61[13%], p< 0.0001) and positive microbial culture (644[92%] vs 380[83%], p< 0.0001) than other antibiotics groups. In adjusted models, patients on V-PT had higher risk of AKI when compared to those who received V-C (RR:1.59; 95%CI: 1.07,2.36; p = 0.021) or vancomycin (RR:1.62; 95%CI: 1.01,2.61; p = 0.045). Only one patient on ceftriaxone developed AKI.

Conclusions: Acute kidney injury risks differ depending on antibiotics treatment type and mode. Antimicrobial stewardship could help reduce the risk of antibiotic-related AKI in CAP patients.