Systematic Review and Metaanalysis of Acute Kidney Injury Associated With Concomitant Vancomycin and Piperacillin/Tazobactam

Concomitant vancomycin and piperacillin/tazobactam (PT) may be associated with increased acute kidney injury (AKI) compared to vancomycin without PT. Medline, Cochrane, and Scopus were searched through October 2016 using vancomycin, piperacillin, tazobactam, and AKI, acute renal failure, or nephrotoxicity. A registered meta-analysis (PROSPERO: CRD42016041646) with relevant scenarios was performed. Fourteen observational studies totaling 3549 patients were analyzed. Concomitant vancomycin and PT was associated with AKI in unadjusted odds ratio (OR, 3.12; 95% confidence interval [CI], 2.04-4.78) and in adjusted OR (aOR, 3.11; 95% CI, 1.77-5.47) analyses. Similar findings were seen assessing studies in adults (aOR, 3.15; 95% CI, 1.72-5.76), children (OR, 4.55; 95% CI, 2.71-10.21), and when <50% of patients received care in an intensive care unit (aOR, 3.04; 95% CI, 1.49-6.22) but not >= 50% (aOR, 2.83; 95% CI, 0.74-10.85). Increased AKI with concomitant vancomycin and PT should be considered when determining beta-lactam therapy.