Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Jan 7;25(1):36.
doi: 10.1186/s12879-024-10227-0.

Evaluating the risk of acute kidney injury and mortality associated with concomitant use of vancomycin with piperacillin/tazobactam or meropenem in critically ill and non-critically ill patients: a systematic review and meta-analysis

Affiliations
Meta-Analysis

Evaluating the risk of acute kidney injury and mortality associated with concomitant use of vancomycin with piperacillin/tazobactam or meropenem in critically ill and non-critically ill patients: a systematic review and meta-analysis

Abdulmajeed M Alshehri et al. BMC Infect Dis. .

Abstract

Background: There are conflicting findings regarding the risk of acute kidney injury (AKI) and mortality with vancomycin/piperacillin-tazobactam combination (VPT) and vancomycin/meropenem (VM). The aim of this meta-analysis was to compare the risk of AKI and mortality between VPT and VM.

Methods: Observational studies reporting the incidence of AKI and mortality in patients receiving VPT or VM between January 2017 and September 2024 were retrieved from PubMed, the Cochrane Library, and Web of Science. The primary outcome of the analysis was the risk of AKI, and the secondary outcomes were the mortality rate, need for renal replacement therapy (RRT), and hospital length of stay (LOS). This meta-analysis was conducted using a random-effects model to estimate the odds ratios (OR) and 95% confidence intervals (CI) for AKI, mortality, and RRT or mean difference and 95% CI for the LOS.

Results: Seventeen studies involving a total of 80,595 patients were included in the analysis. The odds of developing AKI were higher among patients who received the VPT versus those who received the VM combination (OR = 2.02; 95%CI 1.56-2.62). There were no differences between VPT and VM in the mortality and hospital length of stay; however, the odds of requiring RRT were higher among VPT group versus VM group (OR = 1.55; 95%CI 1.23-1.96).

Conclusion: The findings suggest that the use of VPT is associated with a higher risk of AKI compared to VM and highlight the need for cautious antibiotic selection and monitoring of renal function in patients receiving these combinations.

Keywords: Acute kidney injury; Beta-lactams; Meropenem; Nephrotoxicity; Piperacillin-tazobactam; Vancomycin.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram for selection of studies for the meta-analysis
Fig. 2
Fig. 2
Risk of acute kidney injury (AKI) in vancomycin/piperacillin-tazobactam combination (VPT) [Experimental group] versus vancomycin with meropenem (VM) [control group]. I2 = 72.3% [CI 54.9%; 82.9%]
Fig. 3
Fig. 3
Risk of mortality in vancomycin/piperacillin-tazobactam combination (VPT) [Experimental group] versus vancomycin with meropenem (VM) [control group]. I2 = 57.5% [Cl 6.6%; 80.6%]
Fig. 4
Fig. 4
Renal replacement therapy in vancomycin/piperacillin-tazobactam combination (VPT) [Experimental group] versus vancomycin with meropenem (VM) [control group]. I2 = 0.0% [Cl 0.0%; 79.2%]
Fig. 5
Fig. 5
Hospital length of stay in vancomycin/piperacillin-tazobactam combination (VPT) [Experimental group] versus vancomycin with meropenem (VM) [control group]. I2 = 62.5% [19.3%; 82.6%]

Similar articles

References

    1. Levey A.S. Defining AKD: the Spectrum of AKI, AKD, and CKD. Nephron. 2022;146(3):302–5. 10.1159/000516647. - PubMed
    1. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A. Acute kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31. 10.1186/cc5713. - PMC - PubMed
    1. Sawada A, Kawanishi K, Morikawa S, Nakano T, Kodama M, Mitobe M, Taneda S, Koike J, Ohara M, Nagashima Y, et al. Biopsy-proven Vancomycin-induced acute kidney injury: a case report and literature review. BMC Nephrol. 2018;19(1):72. 10.1186/s12882-018-0845-1. - PMC - PubMed
    1. Kim T, Kandiah S, Patel M, Rab S, Wong J, Xue W, Easley K, Anderson AM. Risk factors for kidney injury during Vancomycin and piperacillin/tazobactam administration, including increased odds of injury with combination therapy. BMC Res Notes. 2015;8(1):579. 10.1186/s13104-015-1518-9. - PMC - PubMed
    1. Contreiras C, Legal M, Lau TT, Thalakada R, Shalansky S, Ensom MH. Identification of risk factors for nephrotoxicity in patients receiving extended-duration, high-trough Vancomycin therapy. Can J Hosp Pharm. 2014;67(2):126–32. 10.4212/cjhp.v67i2.1340. - PMC - PubMed

MeSH terms

LinkOut - more resources