Is the Combination of Piperacillin-Tazobactam and Vancomycin Associated with Development of Acute Kidney Injury? A Meta-analysis.
Pharmacotherapy. 2016 Nov 2;:
Authors: Giuliano C, Patel CR, Kale-Pradhan PB
Abstract
STUDY OBJECTIVE: To evaluate the association of the development of acute kidney injury (AKI) when piperacillin-tazobactam is used in combination with vancomycin compared with vancomycin with or without a β-lactam.
DESIGN: Meta-analysis of 15 observational cohort studies.
PATIENTS: A total of 3258 adult inpatients who received vancomycin + piperacillin-tazobactam versus vancomycin alone (10 studies); vancomycin + piperacillin-tazobactam versus vancomycin + β-lactam (four studies); or vancomycin + piperacillin-tazobactam versus vancomycin alone or vancomycin + other antibiotics (one study).
MEASUREMENTS AND MAIN RESULTS: The PubMed, Embase, CINAHL, and Cochrane databases, as well as meeting proceedings, were searched (1966 to June 1, 2016). Quality of studies was assessed by using the Newcastle Ottawa Quality Assessment Scale (NOQAS). The primary outcome of this meta-analysis was to evaluate the association of development of AKI with the combined use of piperacillin-tazobactam and vancomycin. A subgroup analysis was also performed, which examined the outcome by comparison groups (vancomycin alone or vancomycin + β-lactam). Sensitivity analysis was performed to explore if the results differed based on removal of abstracts and removal of low-quality studies (NOQAS scores ≤ 6). All analyses were performed using the random effects model. NOQAS scores for the 15 studies ranged from 3-7 (of a total of 9) points. Overall, there was an association with the development of AKI with vancomycin + piperacillin-tazobactam compared with vancomycin ± β-lactam (odds ratio [OR] 3.649, 95% CI 2.157-6.174; I(2) =83.5%, p<0.001). The association remained significant when abstracts were removed (OR 3.498, 95% CI 1.747-7.003, I(2) =82.3%, p<0.001) and when low-quality studies were removed (OR 4.596, 95% CI 2.929-7.212, I(2) =0%, p<0.001). The association for the development of AKI with vancomycin + piperacillin-tazobactam compared with vancomycin alone was significant (OR 3.980, 95% CI 2.749-5.763, I(2) =31.4%, p<0.001), although the association did not remain significant for the vancomycin + β-lactam subgroup (OR 3.029, 95% CI 0.942-9.738, I(2) =82.3%, p=0.063).
CONCLUSION: Vancomycin + piperacillin-tazobactam was associated with increased risk of AKI compared to vancomycin ± β-lactam. Practitioners need to be vigilant about this association when prescribing this combination of antibiotics. This article is protected by copyright. All rights reserved.
PMID: 27805728 [PubMed - as supplied by publisher]