Acute kidney injury associated with concomitant use of vancomycin with piperacillin-tazobactam: a focused review and meta-analysis

Abstract

Acute kidney injury (AKI) occurs frequently during the administration of certain medications in hospitalized patients and increases morbidity and mortality. The vancomycin and piperacillin/tazobactam combination is one of the most commonly used empiric antibiotic regimens in hospitalized patients to provide adequate coverage of drug-resistant pathogens. Recent studies suggest that this combination may be associated with more AKI than vancomycin monotherapy or vancomycin in combination with other antibiotics. We performed a literature review with a meta-analysis of published studies to evaluate the possible association between combination therapy with vancomycin and piperacillin/tazobactam and higher rates of AKI. Although the studies were heterogeneous, the meta-analysis suggests a higher rate of AKI with the concurrent use of piperacillin/tazobactam and vancomycin compared to vancomycin monotherapy or vancomycin combination with cefepime or meropenem. Prospective, randomized studies with larger sample sizes across multiple centers, controlling for potential confounding factors, are needed to validate this association.

Keywords

• vancomycin
• piperacillin-tazobactam
• nephrotoxicity
• acute kidney injury
• meta-analysis