Title : Comparative risk of acute kidney injury with piperacillin–tazobactam plus teicoplanin versus piperacillin–tazobactam plus vancomycin: A systematic review and meta-analysis of propensity score-matched studies
Abstract:
Background: Piperacillin–tazobactam combined with vancomycin is widely employed for broad-spectrum empiric coverage but has been increasingly associated with acute kidney injury (AKI). The comparative renal safety of substituting vancomycin with teicoplanin remains uncertain. This meta-analysis aimed to evaluate renal outcomes between piperacillin–tazobactam plus teicoplanin (TZP-TEI) and piperacillin–tazobactam plus vancomycin (TZP-VAN).
Methods: We searched PubMed, Scopus, and Cochrane Central for studies comparing TZP–TEI to TZP–VAN in hospitalized patients. The primary outcome was the incidence of AKI, defined according to KDIGO or RIFLE criteria. Statistical analysis was conducted using Review Manager 5.4 (Cochrane Collaboration), and heterogeneity was assessed using the I² statistic.
Results: A total of 908 patients were included from five cohort studies, four of which implemented propensity score matching to adjust for baseline confounding. The mean age of the included patients was 65 years, and the mean baseline serum creatinine concentration was 0.75 mg/dL. The TZP–TEI regimen was associated with a significantly reduced rate of AKI compared to TZP–VAN (OR 0.52; 95% CI 0.30–0.89; p = 0.02; I² = 51%). No statistically significant differences were observed between groups for AKI recovery (OR 0.68; 95% CI 0.41–1.12; p = 0.13; I² = 0%) or for 30-day all-cause mortality (OR 1.34; 95% CI, 0.77–2.32; p = 0.30; I² = 0%). Subgroup analyses stratified by AKI severity (KDIGO stages 1–3 or RIFLE criteria) demonstrated consistent directionality across stages, with no significant differences observed within propensity score–matched or non–matched cohorts.
Conclusion: The TZP-TEI combination was associated with a significantly lower incidence of AKI compared to TZP–VAN. Further studies are warranted to validate these findings, optimize teicoplanin dosing within the TZP–TEI combination, and inform TDM implementation in high-risk hospitalized patients.
