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Vancomycin Piperacillin-Tazobactam AKI — ESENeph MCQ

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ModerateAcute Kidney InjuryVancomycin Piperacillin-Tazobactam AKIESENeph

A 60-year-old man develops AKI 7 days after starting Vancomycin and Piperacillin-Tazobactam for a severe soft tissue infection. His Vancomycin trough is 18 mg/L (within range). Creatinine has risen from 90 to 250 umol/L. What is the most likely mechanism?

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Correct answer: E — Synergistic nephrotoxicity from Vancomycin plus Piperacillin-Tazobactam combination

The combination of Vancomycin plus Piperacillin-Tazobactam (Tazocin) has been shown in multiple large studies to have significantly higher AKI rates compared to Vancomycin plus Cefepime or Vancomycin plus Meropenem. The mechanism appears to be synergistic tubular toxicity. The ACORN trial (2024) confirmed this increased risk. Where possible, alternative beta-lactam combinations should be considered when Vancomycin is required.

Reference: Luther et al 2018 – VPT Nephrotoxicity Meta-analysis; ACORN Trial – JAMA 2024