Antibiotic Combination for Hospitalized Children May Increase Risk of Kidney Injury: Study

Children who are given certain combinations of IV antibiotics while hospitalized may face have an increased risk of suffering acute kidney injury, according to the findings of new research. 

In a study published this week in the medical journal JAMA Pediatrics, researchers warn that the use of intravenous antibiotic combinations of vancomycin together with piperacillin/tazobactam (TZP) have caused children to suffer acute kidney injury at nearly three times the rate of those who did not receive the antibiotic combination therapy.

Researchers evaluated data from six large children’s hospitals across the country from January 1, 2007, through December 31, 2012. They used data from the Pediatric Health Information System Plus database, which contains administrative and laboratory data from six pediatric hospitals in the U.S.

Data included information for more than 1,900 patients, ages six months to 18 years of age, who were admitted through the ER. Those with underlying kidney disease or abnormal serum creatinine levels were excluded from the study.

Children involved in the study stayed at the hospital for a minimum of three days, and often stayed for up to seven days.

Patients were either given intravenous vancomycin plus TZP, also sold under the brand name Zosyn, or vancomycin with another antipseudomonal β-lactam antibiotic, such as ceftazidime sodium, cefepime hydrochloride, meropenem, and imipenem/cilastin sodium.

Of the children who were given vancomycin with TZP, 11% developed acute kidney injury. Comparatively, 4% of children who took one of the other combination antibiotics developed acute kidney injury, which involves the sudden loss of renal function and may lead to chronic kidney disease or kidney failure.

Overall, children who developed acute kidney injury had longer hospital stays;13 days compared to 10 for children who didn’t have kidney injury. Those children also had higher rates of in-hospital mortality; 4.5% vs 1.3%. They also were usually older, at an average age of 12 years old compared to 5 years old, and admitted to the intensive care unit during their first few days of their hospital stay.

The incidence of acute kidney injury across the six hospitals ranged from 4% to 11.5%.

Vancomycin is used to treat gram-positive infections, like methicillin resistant staphaureus (MRSA). Similarly, β-lactam antibiotics are often given to treat gram-negative infections, such as lyme disease and pneumonia, and provide a broad spectrum coverage to treat a wide range of infections before the pathogen is identified.

Other studies have shown TZP combination antibiotics increase the risk of kidney injury in adults, but this is the first study to show the same effects on children.

Researchers warn, pediatricians should be aware of the potential risk to children and limit the duration of vancomycin plus TZP combination therapy. When other options are available that will appropriately treat the patient, those should be used. When there are no other forms of treatment, doctors should closely monitor the patient and their kidney function when they are given the combination antibiotics.