Is there an association between vancomycin-piperacillin-tazobactam and renal failure?

The CAMERA-2 research, a medical trial involving roughly 350 sufferers and combining monotherapy versus mixture remedy, was stopped early due to a beta-lactam (primarily piperacillin-tazobactam) mixture.) vancomycin will be extraordinarily nephrotoxic. Since then, the scientific group has centered on finding out and higher understanding this association as a result of it’s a broadly used routine in intensive care as a result of it’s MRSA and Pseudomonas. A current potential research by Miano and so forth. was the primary to guage the chance of acute kidney harm attributable to the vancomycin-piperacillin-tazobactam mixture.


It included 739 sufferers from a sepsis database who obtained vancomycin + cefepime or vancomycin + tazocin for 48 hours. They evaluated biomarkers of kidney perform (creatinine, cystatin C, and urea) earlier than and 48 hours after therapy. In addition, they evaluated acute kidney harm and dialysis on the thirtieth day of statement and on the 14th day of demise.


There have been 297 sufferers within the vancomycin-piperacillin-tazobactam arm and 442 within the vancomycin-cefepime arm. However, solely 192 sufferers have been capable of assess cystatin C values. The tazocin arm was related to a larger share improve in creatinine on the second day (8.04% – 95percentCI 1.21-15.34) and the next incidence of acute kidney harm (RR 1.34 – 95percentCI 1.01-1.78). However, this was not related to adjustments in renal perform biomarkers or medical end result. Cystatin C dose, for instance, was comparable between the 2 regimens (1.51 for the vancomycin-tazocin arm and 1.52 for the vancomycin-cefepime arm). These findings led the authors to theorize that this association really causes renal pseudotoxicity. In different phrases, the rise of creatinine within the blood is because of the violation of creatinine secretion within the tubes.


In reality, piperacillin-tazobactam-induced inhibition of anion transporters can have an effect on renal excretion of creatinine, resulting in serum elevations of the substance enough to warrant a prognosis of acute kidney harm in accordance with the KDIGO standards. However, there isn’t any impact on glomerular filtration fee and therefore pseudonephrotoxicity that doesn’t result in extreme acute kidney harm requiring renal alternative remedy.

Some different features should be touched upon earlier than drawing a closing conclusion on this matter. First, beforehand revealed research nonetheless have observational samples and this isn’t distinctive. The a rule. Second, a research revealed by Miano and so forth. it is a Only 192 sufferers had cystatin C measurements, single-center and restricted in sampling. It needs to be famous that cystin C is an attention-grabbing different to creatinine, however it’s nonetheless a useful biomarker with important limitations, as it’s affected by many situations and medicine (e.g. , tumors, diabetes and corticosteroids). In Miano’s evaluation and so forth.More than 50% of sufferers used corticosteroids, which can improve cystatin C manufacturing. Finally, acute kidney harm can happen as much as seven days and the evaluation was carried out after 48 hours of the antimicrobial routine.

Also learn: Cumulative doses of topical antibiotic powder improve the chance of acute renal failure?

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In any case, this new research demonstrated the added worth and practicality of utilizing a number of useful biomarkers with completely different potential not just for analysis but in addition for the clinic, and it was a step towards dispelling considerations about unwanted side effects. complicated mixtures of antimicrobial brokers.

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