Assessment of acute kidney injury associated with the concomitant use of piperacillin/tazobactam and vancomycin in pediatric cancer patients

Abstract

This study aimed to evaluate the renal safety of concomitant piperacillin/tazobactam (Pip-Taz) and vancomycin in pediatric cancer patients by assessing changes in the serum creatinine (SCr) and blood urea nitrogen (BUN) levels. The hospital information system at Shaukat Khanum Memorial Cancer Hospital and Research Centre was used to extract the required information, and laboratory test results were collected for 100 randomly selected patients in whom both Pip-Taz and vancomycin were used. Patients were randomly selected using a computer-generated list to minimize selection bias. The data obtained were statistically analyzed using the Friedman test. Most patients who received Pip-Taz and vancomycin suffered from pre-B lymphocytic leukemia. The Friedman test revealed significant within-group differences in SCr and BUN over time (χ² = 299.945, p < 0.001 for males; χ² = 170.162, p < 0.001 for females), but all posttherapy values remained within normal physiological ranges. Posttherapy, vancomycin-treated patients had slightly lower SCr and BUN levels than did those receiving Pip-Taz, although all values remained within normal ranges. A similar trend was observed in females. These findings suggest that concomitant Pip-Taz and vancomycin did not result in significant nephrotoxicity, as all renal biomarker changes remained within normal ranges. No patients met the acute kidney injury (AKI) criteria during therapy. However, vancomycin-treated patients presented slightly greater reductions in creatinine and BUN levels than did Pip-Taz-treated patients, although this does not indicate improved renal function. Despite these findings, vancomycin’s potential for nephrotoxicity remains an important consideration in pediatric treatment decisions