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Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin With Concomitant

Ranyi Li1, Yanli Li1, Chenqi Xu2

  • 1Department of Pharmacy, ZhongShan Hospital, Fudan University, Shanghai, China.

The Journal of Pharmacy Technology : Jpt : Official Publication of the Association of Pharmacy Technicians
|July 30, 2025
PubMed

Insights

Vancomycin plus piperacillin-tazobactam (PTZ) increases acute kidney injury (AKI) risk in critically ill patients compared to other beta-lactams. Children are at higher risk, necessitating further high-quality research.

Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Pharmacology

Background:

  • Evidence regarding the association between vancomycin (VAN) plus piperacillin-tazobactam (PTZ) and acute kidney injury (AKI) in critically ill patients is conflicting.
  • This combination is frequently used, highlighting the need for clarity on its nephrotoxic potential.

Purpose of the Study:

  • To investigate the risk of AKI associated with VAN plus PTZ compared to VAN plus other beta-lactams (BLs) or monotherapy in critically ill patients.
  • To identify patient subgroups, such as children, who may be at increased risk.

Main Methods:

  • A systematic search of major databases (PubMed, Cochrane, Web of Science, Embase) was conducted up to June 2024.
  • Included studies compared AKI risk in critically ill patients receiving VAN+PTZ versus VAN+other BLs or monotherapy.
  • Meta-analysis of 20 retrospective studies involving 28,243 participants was performed.

Main Results:

  • VAN plus PTZ was significantly associated with a higher risk of AKI compared to VAN plus other BLs (OR = 1.66).
  • Children demonstrated a markedly higher risk of AKI with VAN+PTZ compared to adults (OR = 3.16 vs 1.59).
  • VAN plus PTZ was linked to a greater risk of severe stage 2 to 3 AKI (OR = 1.63).

Conclusions:

  • Vancomycin plus piperacillin-tazobactam is associated with an increased risk of AKI and severe AKI in critically ill patients, particularly in children.
  • No significant differences in mortality, dialysis, time to AKI, or length of stay were observed.
  • High-quality, multicenter, prospective cohort, and randomized controlled studies are required to confirm these findings.
Keywords:
acute kidney injurybeta-lactamscritically illpiperacillin-tazobactamvancomycin

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