Monday, July 11, 2016

Is piperacillin-tazobactam nephrotoxic

PulmCrit (EMCrit)
PulmCrit - July 9, 2016 - By Josh Farkas
"A recent series of articles suggest that the combination of vancomycin and piperacillin-tazobactam are synergistically nephrotoxic (reviewed by Bryan Hayes here). This is an ongoing topic of debate, pending discussion this week at the Twitter Nephrology Journal Club. It has sparked some interesting articles, including the epic title shown here:
Seriously though, this is an important question: are we hurting our patients with piperacillin-tazobactam? Let’s take it one step at a time..."

  • Piperacillin-tazobactam may increase serum creatinine due to a reduction in tubular creatinine secretion, caused by inhibition of the organic anion transporter. This causes “pseudo-nephrotoxicity” – increase serum creatinine, without impaired renal function or true renal injury.
  • In recent studies, piperacillin-tazobactam is associated with an increased creatinine, but also a trend towardless dialysis. Thus, elevations in creatinine due to piperacillin-tazobactam might not be clinically relevant.
  • Current evidence does not support a change in practice due to concerns regarding nephrotoxicity. For now, I will keep on sending in Maverick.