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

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 I 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; I = 51%). No statistically significant differences were observed between groups for AKI recovery (OR 0.68; 95% CI 0.41-1.12; p = 0.13; I = 0%) or for 30-day all-cause mortality (OR 1.34; 95% CI 0.77-2.32; p = 0.30; I = 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.