ArticleIntensive care medicine2022
Association of vancomycin plus piperacillin-tazobactam with early changes in creatinine versus cystatin C in critically ill adults: a prospective cohort study.
Article in Intensive care medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 52 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Markers of Nephrotoxicity During Treatment With Antibiotic Combinations: A Pragmatic Clinical Trial
A Randomized Controlled Trial Comparing Renal Effects of Vancomycin Combined With Either Piperacillin/Tazobactam or Meropenem: VPT Patient Safety (VPS) Study
Who cites it
52 citing papers in PubMed, 4 syntheses or guidelines pooled it, 90 citations in OpenAlex.
- Pooled it
- Association between concomitant use of vancomycin-piperacillin/tazobactam and acute kidney injury in real-world setting.Frontiers in physiology · 2026Pooled it
- Evaluating the risk of acute kidney injury and mortality associated with concomitant use of vancomycin with piperacillin/tazobactam or meropenem in critically ill and non-critically ill patients: a systematic review and meta-analysis.BMC infectious diseases · 2025Pooled it
- Evaluating the Nephrotoxicity of Area-under-the-Curve-Based Dosing of Vancomycin with Concomitant Antipseudomonal Beta-Lactam Antibiotics: A Systematic Review and Meta-Analysis.Medicina (Kaunas, Lithuania) · 2023Pooled it
- Overview of pseudo-acute kidney injury.Renal failure · 2026Review
- Incidence and risk factors of vancomycin-associated nephrotoxicity among neonates in the intensive care unit: a retrospective cohort study.Pediatric nephrology (Berlin, Germany) · 2026Article
- Impact of vancomycin administration modality on target attainment in acutely ill children-a propensity score matching analysis.European journal of pediatrics · 2026Article
- The impact of vancomycin and piperacillin-tazobactam combination therapy on the incidence of acute kidney injury: a retrospective review.Proceedings (Baylor University. Medical Center) · 2026Observational
- Infectious consequences of antimicrobial change from vancomycin-piperacillin/ tazobactam to vancomycin-cefepime in the prevention of AKI during orthotopic heart transplantation.BMC infectious diseases · 2026Article
- Piperacillin/tazobactam plus erythromycin improves clinical outcomes in AECOPD with bacterial lower respiratory tract infections: a retrospective cohort study.Scientific reports · 2026Article
- Development and Validation of a Novel Scoring Model Integrating Clinical Risk Factors and Pharmacokinetic Parameters to Predict Vancomycin-Induced Nephrotoxicity.Pharmacotherapy · 2026Article
- From suspected necrotizing fasciitis to diagnosed drug-induced fever: a diagnostic maze and reflections on anti-infection management in a case of postoperative fever after femoral fracture.Frontiers in medicine · 2026Article
- Parsimonious Subphenotyping Algorithms Perform Differently in Patients With Sepsis and Hematologic Malignancy.Critical care medicine · 2025Article
- Application of serum STIM1, AOPPS, and urinary NGAL, AGT in the diagnosis of hypertensive nephropathy.Renal failure · 2025Article
- Anti-Infective-Associated AKI: A Narrative Review of the Epidemiology, Mechanisms, Risk Factors, Biomarkers, Clinical Course, Monitoring, Prevention, and Therapeutic Strategies.Antibiotics (Basel, Switzerland) · 2025Review
- [Empirical antibiotic therapy in life-threatening infections-current concepts and controversies].Die Anaesthesiologie · 2025Article
- Predictive Nomogram for Acute Kidney Injury Risk with Vancomycin and Piperacillin Tazobactam in Sepsis Treatment.Medical science monitor : international medical journal of experimental and clinical research · 2025Article
- Transition From Intraoperative Vancomycin-Piperacillin Tazobactam to Vancomycin-Cefepime Does Not Change Acute Kidney Injury or Renal Recovery Outcomes in Patients Undergoing Heart Transplantation.Clinical transplantation · 2025Article
- Shortening the interval between the first and the second dose of vancomycin facilitates rapid achievement of the target AUC without increasing the risk of acute kidney injury, provided the AUC on the second day is appropriately controlled: a multicenter retrospective study.Journal of pharmaceutical health care and sciences · 2025Article
- Identifying a unique signature of sepsis in patients with pre-existing cirrhosis.Critical care (London, England) · 2025Article
Corrections and comments
- Commented on by
Authors and funding
18 authors at 2 institutions in 1 country.
Funding
Abstract
purposeAlthough dozens of studies have associated vancomycin + piperacillin-tazobactam with increased acute kidney injury (AKI) risk, it is unclear whether the association represents true injury or a pseudotoxicity characterized by isolated effects on creatinine secretion. We tested this hypothesis by contrasting changes in creatinine concentration after antibiotic initiation with changes in cystatin C concentration, a kidney biomarker unaffected by tubular secretion.
methodsWe included patients enrolled in the Molecular Epidemiology of SepsiS in the ICU (MESSI) prospective cohort who were treated for ≥ 48 h with vancomycin + piperacillin-tazobactam or vancomycin + cefepime. Kidney function biomarkers [creatinine, cystatin C, and blood urea nitrogen (BUN)] were measured before antibiotic treatment and at day two after initiation. Creatinine-defined AKI and dialysis were examined through day-14, and mortality through day-30. Inverse probability of treatment weighting was used to adjust for confounding. Multiple imputation was used to impute missing baseline covariates.
resultsThe study included 739 patients (vancomycin + piperacillin-tazobactam n = 297, vancomycin + cefepime n = 442), of whom 192 had cystatin C measurements. Vancomycin + piperacillin-tazobactam was associated with a higher percentage increase of creatinine at day-two 8.04% (95% CI 1.21, 15.34) and higher incidence of creatinine-defined AKI: rate ratio (RR) 1.34 (95% CI 1.01, 1.78). In contrast, vancomycin + piperacillin-tazobactam was not associated with change in alternative biomarkers: cystatin C: - 5.63% (95% CI - 18.19, 8.86); BUN: - 4.51% (95% CI - 12.83, 4.59); or clinical outcomes: dialysis: RR 0.63 (95% CI 0.31, 1.29); mortality: RR 1.05 (95%CI 0.79, 1.41).
conclusionsVancomycin + piperacillin-tazobactam was associated with creatinine-defined AKI, but not changes in alternative kidney biomarkers, dialysis, or mortality, supporting the hypothesis that vancomycin + piperacillin-tazobactam effects on creatinine represent pseudotoxicity.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.