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Background <p>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.</p> Objective <p>This meta-analysis aimed to evaluate renal outcomes between piperacillin–tazobactam plus teicoplanin (TZP–TEI) versus piperacillin–tazobactam plus vancomycin (TZP–VAN).</p> Methods <p>PubMed, Scopus, and Cochrane Central were searched for studies comparing TZP–TEI versus TZP–VAN in hospitalized patients. The primary outcome was AKI incidence, defined by Kidney disease: Improving global outcomes (KDIGO) or RIFLE (Risk of renal dysfunction, Injury to kidney, Failure or Loss of kidney function, and End-stage kidney disease) criteria. Data were analyzed using Review Manager, with heterogeneity assessed via the <i>I</i><sup>2</sup> statistic.</p> Results <p>A total of 908 patients were included from five cohort studies, four of which applied propensity-score matching (PSM), with reported ages ranging from 56.8 to 79 years. The TZP–TEI regimen was associated with a significantly reduced rate of AKI compared with TZP–VAN (odds ratio [OR] 0.52; 95% confidence interval [CI] 0.30–0.89; <i>p</i> = 0.02; <i>I</i><sup>2</sup> = 51%). No statistically significant differences were observed between groups for AKI recovery (OR 0.68; 95% CI 0.41–1.12; <i>p</i> = 0.13; <i>I</i><sup>2</sup> = 0%) or for 30-day all-cause mortality (OR 1.34; 95% CI 0.77–2.32; <i>p</i> = 0.30; <i>I</i><sup>2</sup> = 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 PSM or non-PSM cohorts.</p> Conclusion <p>The TZP–TEI combination was associated with a significantly lower incidence of AKI than was TZP–VAN. Further studies are warranted to validate these findings, optimize teicoplanin dosing within the TZP–TEI combination, and inform therapeutic drug monitoring implementation in high-risk hospitalized patients.</p>

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Comparative Risk of Acute Kidney Injury with Piperacillin–Tazobactam Plus Teicoplanin Versus Piperacillin–Tazobactam Plus Vancomycin: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2025年9月12日

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  • Shahd Mohammad,
  • Haneen Ghazal,
  • Wafaa Rahimeh,
  • Maqsood Khan,
  • Mosab Al Balas,
  • Faris El-Dahiyat

摘要

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.

Objective

This meta-analysis aimed to evaluate renal outcomes between piperacillin–tazobactam plus teicoplanin (TZP–TEI) versus piperacillin–tazobactam plus vancomycin (TZP–VAN).

Methods

PubMed, Scopus, and Cochrane Central were searched for studies comparing TZP–TEI versus TZP–VAN in hospitalized patients. The primary outcome was AKI incidence, defined by Kidney disease: Improving global outcomes (KDIGO) or RIFLE (Risk of renal dysfunction, Injury to kidney, Failure or Loss of kidney function, and End-stage kidney disease) criteria. Data were analyzed using Review Manager, with heterogeneity assessed via the I2 statistic.

Results

A total of 908 patients were included from five cohort studies, four of which applied propensity-score matching (PSM), with reported ages ranging from 56.8 to 79 years. The TZP–TEI regimen was associated with a significantly reduced rate of AKI compared with TZP–VAN (odds ratio [OR] 0.52; 95% confidence interval [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 PSM or non-PSM cohorts.

Conclusion

The TZP–TEI combination was associated with a significantly lower incidence of AKI than was TZP–VAN. Further studies are warranted to validate these findings, optimize teicoplanin dosing within the TZP–TEI combination, and inform therapeutic drug monitoring implementation in high-risk hospitalized patients.