Piperacillin Nephrotoxicity Is Driven by Elevated Serum Trough Concentrations

Beta-lactams such as piperacillin have been associated with acute kidney injury (AKI), especially when given with vancomycin. Elucidating the details of drug-induced AKI is challenging in the context of critical illness, itself a source of nephrotoxicity. Girdwood and colleagues evaluated piperacillin exposure in critically ill children and young adults to determine pharmacokinetic and clinical features associated with AKI. Repeated measurements of free piperacillin serum concentration were applied to a statistical pharmacokinetic model to estimate area under the curve exposure in the first 24 hours (AUC24), highest peak concentration in the first 24 hours (C_max24), and highest trough concentration in the first 24 hours (C_min24). Piperacill…