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