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Acute kidney injury associated with concomitant vancomycin and piperacillin/tazobactam administration: a systematic

Xiao-Yu Chen1, Ri-Xiang Xu1, Xin Zhou1

  • 1Department of Pharmacology, School of Pharmacy, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.

International Urology and Nephrology
|May 13, 2018
PubMed
Abstract

Insights

The combination of vancomycin (VAN) and piperacillin/tazobactam (PT) is associated with a higher risk of acute kidney injury (AKI). This finding suggests careful consideration of VAN and PT use in clinical practice to mitigate potential kidney damage.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Vancomycin (VAN) is a critical antibiotic for acute infections, often co-administered with piperacillin/tazobactam (PT).
  • The potential for this combination to increase the risk of acute kidney injury (AKI) compared to VAN alone is a subject of ongoing clinical debate.

Purpose of the Study:

  • To investigate the correlation between the concurrent administration of VAN and PT and the incidence of AKI.
  • To provide evidence-based insights into the nephrotoxic potential of this common drug combination.

Main Methods:

  • A meta-analysis was performed on eight observational cohort studies, encompassing 10,727 participants.
  • Comprehensive literature searches were conducted across major databases (PubMed, CBM, CNKI, WFDP, CSCD) up to April 2017.
  • Data extraction and risk of bias assessment were performed by two independent reviewers.

Main Results:

  • A statistically significant correlation was identified between the combined use of VAN and PT and an increased risk of AKI (OR 1.57; 95% CI, 1.13-2.01).
  • This association remained consistent even when comparing VAN and PT to VAN and cefepime (OR 1.50; 95% CI, 1.07-1.93).
  • Sensitivity analyses excluding lower-quality studies did not alter the observed correlation (OR 1.49; 95% CI, 1.06-1.92).

Conclusions:

  • The concurrent use of vancomycin and piperacillin/tazobactam is associated with an elevated risk of acute kidney injury.
  • Clinicians should carefully consider this increased nephrotoxicity risk when prescribing VAN and PT in combination.
  • Further research may be warranted to explore mechanisms and mitigation strategies for VAN-PT-induced AKI.
Keywords:
Acute kidney injuryMeta-analysisPiperacillin/tazobactamVancomycin

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