Abstract: Abstract: Objective　To explore the effects of vancomycin (VAN) monotherapy and combination of VAN+piperacillin-tazobactam (TZP) or meropenem (MEM) on the incidence, duration,recovery and clinical prognosis of acute kidney injury (AKI). Methods　A total of 338 sepsis patients admitted to the emergency department of the Second Affiliated Hospital of Hainan Medical College from January 2018 to May 2020 and were given VAN, TZP or MEM and maintained for at least 48 h were enrolled. Of these patients, 78 patients received VAN monotherapy (group VAN)，175 patients received combination therapy with VAN+TZP (group VAN+TZP)，and 85 patients received combination therapy with VAN+MEM(group VAN+MEM). The clinical data，incidence of AKI and clinical outcomes were compared between the three groups. Kaplan-Meier analysis and Log-rank test were performed to compare AKI developmental probability in the three groups. The independent risk factors of AKI were analyzed by multivariate Logistic regression model. Results　The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, and the proportion of norepinephrine use were significantly higher in group VAN+TZP and group VAN+MEM than those in group VAN. The proportion of adrenalin and dopamine use was significantly higher in group VAN+TZP than that in group VAN and group VAN+MEM. Compared with group VAN and group VAN+TZP, patients in group VAN+MEM had the highest proportion of amphotericin and aminoglycoside use, while the proportion of angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) use was the lowest (P＜0.05). There were no significant differences in the duration of antibiotic therapy and mean VAN daily dose between the three groups. The incidence of AKI was significantly higher in group VAN+TZP than that in group VAN and VAN+MEM (50.3% vs.23.1% vs.25.9%, P＜0.001)，while there was no significant difference between group VAN and group VAN+MEM (P＞0.016 7). The proportion of AKI stage 2 in group VAN+TZP was significantly higher than that in group VAN and group VAN+MEM (21.7% vs.7.7% vs.9.4%, P＜0.01). There were no significant differences in the dialysis within 30 days, the recovery rate of AKI, serum creatinine (SCr) at AKI recovery, duration of AKI, length of hospital stay and 30-day mortality between the three groups (P＞0.05). The Kaplan-Meier analysis showed that the cumulative risk of AKI was significantly higher in group VAN+TZP than that in group VAN and group VAN+MEM (log-rankχ2=14.491, P=0.001). Multivariate Logistic regression model analysis showed that the APACHE Ⅱ scores (OR=1.041, 95%CI: 1.008-1.075, P=0.013)， the use of norepinephrine (OR=2.200, 95%CI: 1.254-3.860, P=0.006) and the combination therapy of VAN+TZP (OR=2.064, 95%CI: 1.104-3.856, P=0.023) were independent risk factors for AKI. Conclusion　The AKI incidence in sepsis patients treated with VAN+TZP is higher than those treated with VAN monotherapy and VAN+MEM. However, this does not have a decisive influence on final clinical outcomes.  

Key words: Vancomycin, Piperacillin, sepsis, acute kidney injury, prognosis, APACHEⅡ, risk factors, meropenem