Piperacillin-Tazobactam(Zosyn) and vancomycin is the new PPI
on the block. It seems that this combination is also nephrotoxic. While I had
noticed this observation in practice, I was unsure if this was a vancomycin
effect or zosyn effect. A recent prospective study done by Peyko et al elegantly shows that AKI incidence( as defined
by KDIGO) was significantly higher in the Zosyn/vancomycin group compared to
cefepime or meropenem and vancomycin group.
This is an important study to help spark more interest in looking into
this topic.
Some interesting points regarding the study:
Single center, prospective trial, all sepsis patients were
reviewed. Interestingly, there were twice as many patients in the zosyn
arm. 18 patients required HD in the
zosyn arm compared to 8 in the meropenem or cefepime arm. The vancomycin levels
were no different in both arms. The authors
stress that perhaps the study was underpowered but clearly there is a signal of
AKI more than the other arm.
Interestingly, in the last 5 years, several retrospective
studies have shown the concern for this combination to be nephrotoxic. Few of the references are listed below:
Check out tomorrow’s NephJC
journal club on this topic for more discussion
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