Do vancomycin and piperacillin tazobactam cause AKI?
Vancomycin is an antibiotic that inhibits cell wall synthesis in gram-positive bacteria.
The incidence of vancomycin-induced nephrotoxicity is highly variable, ranging from <1% to >40%, depending on the population studied, dosing regimens, event under/overreporting, and the definitions employed. Risk factors for vancomycin-induced AKI include increased exposure of the kidneys to vancomycin from higher doses or higher trough levels (>20 mg/L) and underlying CKD.
Piperacillin-tazobactam is an antibiotic combination containing an extended-spectrum beta lactam with β-lactamase inhibitor. Retrospective studies demonstrate a significant increase in serum creatinine (incidence ∼30%), with the combination of vancomycin and piperacillin-tazobactam. This may reflect pseudo-nephrotoxicity, a situation where piperacillin competes with creatinine for uptake by the OAT in the proximal tubule. This effect would raise serum creatinine and lead to a diagnosis of AKI. True AKI may also result from either AKI or AIN.
