Evaluating Renal Stress Using Pharmacokinetic Urinary Biomarker Data in Critically Ill Patients Receiving Vancomycin and/or Piperacillin–Tazobactam: A Secondary Analysis of the Multicenter Sapphire Study

摘要: A drug combination that has gained recent attention for an additive risk of nephrotoxicity is vancomycin plus piperacillin–tazobactam. Clinicians need to better understand whether tubular cell stress occurs with piperacillin–tazobactam administration establish renal injury associated this a valid clinical concern. An evaluation the pharmacokinetics urinary tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding-protein 7 (IGFBP7) patients receiving alone, in was conducted impact on acute kidney compare rates dialysis or death at 9 months among these three exposure types. secondary analysis prospective, multicenter Sapphire study (ClinicalTrials.gov identifier NCT01209169) including 35 intensive care units (ICUs) North America Europe performed. Critically ill adult (AKI) were included. Urinary [TIMP-2]∙[IGFBP7] measured serially. Patients who received grouped according their maximum AKI stage within 3 days first dose. Of 723 critically adults admitted ICU, 46% either (n = 110), (n = 156), both (n = 67). The highest day 1 group. 2/3 occurred more frequently than those alone (p = 0.03) but not (p = 0.29). Risk greatest (48%) similar (29%) (35%) (p = 0.03 unadjusted p = 0.048 after adjusting covariates). After combination, there greater release biomarkers develop monotherapy possible increased long-term adverse outcomes.