Systematic Review and Meta-analysis of the Association of Acute Kidney Injury with the Concomitant Use of Vancomycin and Piperacillin-Tazobactam in Children

Markos Kalligeros, Spyridon A. Karageorgos, Fadi Shehadeh, Ioannis M. Zacharioudakis, Eleftherios Mylonakis

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Concomitant use of vancomycin plus piperacillin-tazobactam (TZP) has been associated with increased risk of acute kidney injury (AKI) in hospitalized adults. In this systematic review and meta-analysis, we searched PubMed and EMBASE for pediatric studies examining this hypothesis, with reference to vancomycin monotherapy or in combination with another beta-lactam antibiotic. Of 1,381 nonduplicate studies, 10 met our inclusion criteria. We performed a random-effects meta-analysis, based on crude odds ratios (ORs), and we accounted for both quality of included studies and publication bias. In primary analysis, concomitant vancomycin and TZP use yielded a statistically significant association with the development of AKI. More specifically, children with AKI had higher odds of having been exposed to vancomycin plus TZP than to vancomycin monotherapy (OR, 8.15; 95% confidence interval [CI], 3.49 to 18.99) or to vancomycin plus any other beta-lactam antibiotic (OR, 3.48; 95% CI, 2.71 to 4.46). On the basis of the results of the Newcastle-Ottawa scale quality assessment, a secondary analysis that included only higher-quality studies (6 of 10 studies) again yielded higher odds of exposure to vancomycin plus TZP than to vancomycin plus another beta-lactam antibiotic (OR, 3.76; 95% CI, 2.56 to 5.51). Notably, even after controlling for possible publication bias, our results remained statistically significant (OR, 3.09; 95% CI, 2.30 to 4.14). In conclusion, the concomitant use of vancomycin and TZP could be associated with AKI development and the clinical significance of this potential association needs to be studied further in the pediatric population.

Original languageEnglish (US)
Article numbere01572-19
JournalAntimicrobial Agents and Chemotherapy
Volume63
Issue number12
DOIs
StatePublished - 2019

Keywords

  • AKI
  • Acute kidney injury
  • Children
  • Nephrotoxic
  • Pediatric
  • Piperacillin
  • Tazobactam
  • Vancomycin

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

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