Mohammad Shahd, Ghazal Haneen, Rahimeh Wafaa, Khan Maqsood, Al Balas Mosab, El-Dahiyat Faris
Clinical Pharmacy Department, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates.
Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi, 64141, United Arab Emirates.
Drug Saf. 2025 Sep 12. doi: 10.1007/s40264-025-01611-z.
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) versus piperacillin-tazobactam plus vancomycin (TZP-VAN).
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.
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.
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.
哌拉西林 - 他唑巴坦联合万古霉素被广泛用于广谱经验性抗感染治疗，但越来越多地与急性肾损伤（AKI）相关。用替考拉宁替代万古霉素后的相对肾脏安全性仍不确定。
本荟萃分析旨在评估哌拉西林 - 他唑巴坦联合替考拉宁（TZP - TEI）与哌拉西林 - 他唑巴坦联合万古霉素（TZP - VAN）之间的肾脏结局。
检索PubMed、Scopus和Cochrane Central数据库，查找比较住院患者中TZP - TEI与TZP - VAN的研究。主要结局是AKI发生率，根据肾脏病：改善全球预后（KDIGO）或RIFLE（肾功能障碍风险、肾损伤、肾衰竭或肾功能丧失及终末期肾病）标准定义。使用Review Manager分析数据，通过I统计量评估异质性。
五项队列研究共纳入908例患者，其中四项应用了倾向评分匹配（PSM），报告的年龄范围为56.8至79岁。与TZP - VAN相比，TZP - TEI方案与显著降低的AKI发生率相关（比值比[OR] 0.52；95%置信区间[CI] 0.30 - 0.89；p = 0.02；I = 51%）。两组在AKI恢复（OR 0.68；95% CI 0.41 - 1.12；p = 0.13；I = 0%）或30天全因死亡率（OR 1.34；95% CI 0.77 - 2.32；p = 0.30；I = 0%）方面未观察到统计学显著差异。按AKI严重程度（KDIGO 1 - 3期或RIFLE标准）分层的亚组分析显示各阶段方向一致，在PSM或非PSM队列中均未观察到显著差异。
与TZP - VAN相比，TZP - TEI联合用药的AKI发生率显著更低。有必要进行进一步研究以验证这些发现，优化TZP - TEI联合用药中替考拉宁剂量，并为高危住院患者的治疗药物监测实施提供依据。
