合併給予vancomycin 與piperacillin-tazobactam 是住院感染常使用之經驗性抗生素組合。2011 年起文獻陸續指出vancomycin 併用piperacillin-tazobactam 與較高的急性腎臟損傷發生率 (18 ~ 49%) 相關，相較單用vancomycin 或piperacillintazobactam 風險增加，顯示兩藥品併用對於腎臟毒性有加成影響。本案例為65 歲男性，身高160 cm，體重55 kg，病史包括第二型糖尿病、高血壓、高血脂與曾發生血管母細胞瘤破裂。此次因發燒、呼吸困難就醫，經驗性給予piperacillin-tazobactam 及vancomycin 治療。然而在治療4 天後發生急性腎因性腎損傷，血中肌酸酐從0.9 mg/dL 上升至1.5 mg/dL，20 小時後再上升至3.4 mg/dL，口服升壓劑使用下血壓正常，當日尿量減少至900 mL。因故將抗生素調整為teicoplanin 與meropenem，隨後病人體溫及血壓漸趨穩定。血中肌酸酐數值於停用兩抗生素後4 日達到顛峰5.3 mg/dL，並在停用34 日後降回1.3 mg/dL。依據Naranjo scale 評估為4 分，屬於「可能」。臨床合併給予vancomycin 與piperacillin-tazobactam 應評估效益及急性腎損傷風險，並密切監測腎功能。

Vancomycin plus piperacillin-tazobactam is one of the most commonly used antimicrobial regimen in the clinical setting. Since 2011, it has been reported that the above combination is significantly associated with acute kidney injury (AKI) compared to use of the individual drugs. We report a case of AKI after treatment with this combination. A 65 year-old male with a medical history of type 2 diabetes mellitus, hypertension, hyperlipidemia, and rupture of hemangioblastoma was admitted to the emergency room due to fever and dyspnea. Empirical vancomycin plus piperacillin-tazobactam were prescribed. Acute intrinsic renal injury was observed 4 days after initiating the combination treatment. His serum creatinine increased from 0.9 mg/dL to 1.5 mg/dL, and further increased to 3.4 mg/dL in 20 h. His urine output decreased to 900 mL/day on the same day. His blood pressure was within normal range under oral vasopressor use. Accordingly, the antibiotic regimen was changed to teicoplanin plus meropenem. His serum creatinine increased to a peak level of 5.3 mg/dL 4 days after discontinuing vancomycin and piperacillin-tazobactam. Renal function returned to baseline 34 days later. An adverse drug reaction was considered possible, with a score of 4 on the Naranjo scale. The present case indicates that clinical use of vancomycin plus piperacillin-tazobactam should be done with caution, and renal function should be monitored regularly.