Kidney Week

Abstract: TH-PO065

Nephrotoxicity Associated with Vancomycin and Piperacillin/Tazobactam: Insights from Kidney Biopsy

Session Information

• AKI: Clinical, Outcomes, and Trials - Epidemiology and Pathophysiology
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Yamada, Sofia, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States

Sofia Yamada, MD

• Parada, Xavier F., UMass Memorial Health, Worcester, Massachusetts, United States

Xavier F. Parada, MD

• Pasala, Sphoorthy, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States

Sphoorthy Pasala, MBBS

• Anumolu, Rajesh, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States

Rajesh Anumolu, MBBS

• Alenizi, Saif A., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States

Saif A. Alenizi, MBChB, MPH, FASN

• Weins, Astrid, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States

Astrid Weins, MD, PhD, FASN

• Mount, David B., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States

David B. Mount, MD

Background

The antibiotics vancomycin and piperacillin-tazobactam are co-prescribed together in hospital settings; there are concerns regarding the potential nephrotoxicity. Both antibiotics have been independently implicated in AKI and there is no consensus about any mechanism of injury when administered together. This case series explores kidney biopsy findings in patients receiving these antibiotics, to elucidate potential mechanisms of injury, risk factors and compare them with the literature. Notably, there is minimal biopsy data for patients with AKI after this antibiotic combination

Methods

This is a single center, observational cohort study. Clinical and biopsy data were retrospectively collected from hospitalized AKI patients with recent exposure to vancomycin and piperacillin-tazobactam who underwent native kidney biopsy between Feb/2010 to Nov/2023 at Brigham and Women’s Hospital. All seven included AKI patients were de-identified; since there was no interaction or intervention with human subjects, there is no need for IRB review

Results

Kidney biopsies revealed a range of pathological findings, including acute tubular necrosis (ATN), acute interstitial nephritis (AIN), and tubular injury potentially related to drug induced nephrotoxicity. Notably, among the 7 patients examined, 2 developed acute kidney injury (AKI) within 48 hours of antibiotic prophylaxis, while 1 during day 2, 3 exhibited symptoms on day 3, and 1 on day 5 following the initiation of antibiotic treatment

Conclusion

AKI after co-administration of vancomycin/ piperacillin-tazobactam is an increasingly important clinical problem, with some evidence for “pseudo-AKI” from elevated creatinine levels without acute kidney injury. Here we report that this antibiotic combination is associated with a mixture of ATN and AIN after co-administration, providing new biopsy confirmation of an association with bona fide AKI. Further research is necessary to elucidate underlying mechanisms and develop strategies for early detection and management of antibiotic associated renal toxicity