1411. Tecioplanin (TEI) vs. Vancomycin (VAN) in Combination with Piperacillin-Tazobactam (TZP) or Meropenem (MER) as a Cause of Acute Kidney Injury (AKI)

Abstract

Background. VAN has been shown to cause increased incidence of AKI when combined with TZP. The reason is unknown. TEI is a glycopeptide which may be less nephrotoxic. We compared both glycopeptides in combination with TZP or MER for causing AKI. Methods. A retrospective cohort study was performed between May 2015 and December 2017 in a large tertiary care setting. Evaluation of AKI was made by using RIFLE criteria. Patients ≥18 years were included if they had a baseline serum creatinine available and received one of the combinations tested for at least 48 hours. Exclusion criteria were renal replacement therapy, pregnancy, <48 hours antibiotic therapy and no follow‐up. Results. Overall 456 patients were screened and 379 included in the study. Afer controlling for residual diferences (age, Charlson comorbidity index score, presence of AKI, GFR value, presence of sepsis or septic shock, residing in intensive care unit at the time of antibiotic therapy and number of days of antibiotic therapy), AKI incidence was signifcantly higher in patients receiving TZP‐VAN than those receiving TZP‐TEI and also in patients receiving TZP‐VAN than those with MER‐VAN. No diference in AKI was detected between patients with MER‐VAN and with MER‐TEI (table). Mortality at 7 and 30 days and resolution of AKI at discharge were similar in all groups. Conclusion. TZP causes increased nephrotoxicity when combined with VAN. Combination with TEI may ofset this side effect. Additionally, the higher AKI incidence with TZP‐VAN than MER‐VAN may suggest a particular nephrotoxic synergy between TZP and VAN. Randomized controlled trials should confrm this observation.