2026 Southeastern Residency Conference

Background

A significant portion of hospitalized adults presenting to a hospital may require treatment with broad spectrum antibiotics. Cases involving suspected infections and sepsis are frequent occurrences in which empiric antibiotic use is warranted. Vancomycin and piperacillin/tazobactam (pip/tazo) comprise a widely used antibiotic regimen incorporating a glycopeptide antibiotic and a β-lactam/β-lactamase inhibitor respectively. This regimen provides broad-spectrum activity against Gram-positive, Gram-negative, and anaerobic pathogens including methicillin resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. The aim of this study is to determine the relationship between differing doses of pip/tazo and the incidence of AKI in patients treated with concomitant vancomycin and pip/tazo. By identifying whether higher doses of pip/tazo are associated with increased AKI rates, this research seeks to inform antimicrobial stewardship efforts and optimize patient safety while preserving therapeutic efficacy.

Methods

This retrospective cohort study was conducted to assess the impact of different piperacillin/tazobactam dosing regimens on the incidence of nephrotoxicity for patients receiving concomitant vancomycin therapy. The research site for this study is a 700-bed, not-for-profit, public hospital system in a rural Georgia. In March 2024, the site for this study changed protocol regarding piperacillin/tazobactam administration from 3.375gm to 4.5gm IV extended-infusion. Patients receiving concomitant vancomycin and piperacillin/tazobactam were split into 2 groups based on which piperacillin/tazobactam dosing regimen they received. The Institutional Review Board at the research site approvedwill review the methodology of this study for approval prior to any patient data collection.

Results - Vancomycin + Piperacillin/Tazobactam 3.375g ( n=105): 13 (12.4%) experienced AKI.
                Vancomycin +Piperacillin/Tazobactam 4.5g ( n=105) : 16 (15.2%) experienced AKI. 
                 p-value = 0.55


Conclusion - Currently, there is not evidence to suggest that the change in piperacillin/tazobactam extended infusion dosing at the primary site had an impact on nephrotoxic risk for patients being treated with concomitant VPT therapy.