A Pragmatic Clinical Trial Comparing the Risk of Acute Kidney Injury During Treatment With Vancomycin and Piperacillin-Tazobactam vs. Vancomycin and Cefepime in Hospitalized Patients

Inclusion Criteria: 1. Age of at least 18 years 2. Suspected or confirmed infection based on clinical criteria, for which vancomycin with piperacillin-tazobactam or vancomycin with cefepime was prescribed by the treating clinician, as evidenced by orders being placed in the electronic health record 3. The treating clinician considers both vancomycin with piperacillin- tazobactam or vancomycin with cefepime as acceptable treatment 4. The treating clinician anticipates at least 48 hours of antibiotic treatment Exclusion Criteria: 1. Dialysis dependence or documented end stage kidney disease 2. AKI at baseline 3. Expected survival \<24 hours and/or presence of do not resuscitate orders 4. History of antibiotic-resistant organisms (microbiological culture results showing bacterial isolates with resistant or intermediate susceptibility to any study drug within the prior 90 days) 5. Documented allergy to vancomycin, cephalosporins, or penicillin 6. Suspected central nervous system infection 7. Inability to provide informed consent or lack of proxy for consent 8. Prisoners/incarcerated individuals 9. Known pregnancy or breastfeeding 10. Previous enrollment in this study 11. Receipt of vancomycin, piperacillin-tazobactam, or cefepime for \>24 hours within the preceding 7 days. At the time of screening, one-time doses of vancomycin, with or without piperacillin-tazobactam, or cefepime, will be allowed prior to randomization to avoid treatment delays; such patients must be enrolled within twelve hours of antibiotic administration.