Acute Kidney Injury Risk in Patients Treated with Vancomycin Combined with Meropenem or Cefepime

Matthew S. Sussman, Michelle B. Mulder, Emily L. Ryon, Eva M. Urrechaga, Gabriel A. Lama, Amritpal Bahga, Sarah A. Eidelson, Howard M. Lieberman, Carl I. Schulman, Nicholas Namias, Kenneth G. Proctor

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: No previous studies have determined the incidence of acute kidney injury (AKI) in trauma patients treated with vancomycin + meropenem (VM) versus vancomycin + cefepime (VC). The purpose of this study was to fill this gap. Methods: A series of 99 patients admitted to an American College of Surgeons-verified level 1 trauma center over a two-year period who received VC or VM for >48 hours were reviewed retrospectively. Exclusion criteria were existing renal dysfunction or on renal replacement therapy. The primary outcome was AKI as defined by a rise in serum creatinine (SCr) to 1.5 times baseline. Multi-variable analysis was performed to control for factors associated with AKI (age, obesity, gender, length of stay [LOS], nephrotoxic agent(s), and baseline SCr), with significance defined as p < 0.05. Results: The study population was 50 ± 19 years old, 76% male, with a median LOS of 21 [range 15-39] days, and baseline SCr of 0.9 ± 0.2 mg/dL. Antibiotics, diabetes mellitus, and Injury Severity Score were independent predictors of AKI (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.4-12; OR 9.3; 95% CI 1-27; OR 1.2; 95% CI 1.023-1.985, respectively). The incidence of AKI was higher with VM than VC (10/26 [38%] versus 14/73 [19.1%]; p = 0.049). Conclusions: The renal toxicity of vancomycin is potentiated by meropenem relative to cefepime in trauma patients. We recommend caution when initiating vancomycin combination therapy, particularly with meropenem.

Original languageEnglish (US)
Pages (from-to)415-420
Number of pages6
JournalSurgical infections
Issue number4
StatePublished - May 2021


  • acute kidney injury
  • cefepime
  • meropenem
  • renal failure
  • trauma intensive care
  • vancomycin

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases


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