PURPOSE: To explore whether the vancomycin plus piperacillin/tazobactam (VPT) combination increased risk of acute kidney injury (AKI) compared to vancomycin plus cefepime (VC) in a cohort of Hispanic patients. METHODS: This was a single-center, retrospective study. Adult Hispanic patients receiving at least 48 hours of concomitant vancomycin and (-lactam therapy were included. Patients were excluded if they had documented allergies to study antibiotics, had antibiotics indicated for a central nervous system infection, were pregnant, had cystic fibrosis, a malignancy, or a creatinine clearance level of 30 mL/min or less, or had preexisting AKI within 48 hours before initiation of antibiotics. The primary outcome was the incidence of AKI, defined by a rise in serum creatinine level as described in KDIGO guidelines. A subgroup analysis was performed to assess AKI incidence with stratification into 3 vancomycin area under the curve (AUC) ranges: 400-499 mg · h/L, 500-599 mg · h/L, and ≥600 mg · h/L. RESULTS: A total of 89 patients were included in the study: 45 in the VPT group and 44 in the VC group. AKI occurred in 23 of the patients receiving VPT (51%) compared to 10 of the patients receiving VC (23%) (odds ratio OR, 2.25; 95% confidence interval CI, 1.22-4.16; P = 0.006). For the subgroup analysis, a significant difference was seen in AKI between VPT and VC in the subgroup with a vancomycin AUC of 400-499 mg · h/L (OR, 0.303; 95% CI, 0.102-0.897; P = 0.035). CONCLUSION: This study suggests that there might be higher risk of AKI with VPT in the Hispanic population. Further studies are needed to confirm these findings and to investigate potential ethnicity-specific susceptibility to kidney injury associated with vancomycin combination therapy.
Villa et al. (2026) studied this question.