title: Systematic Review and Meta-Analysis of Acute Kidney Injury Associated with Concomitant Vancomycin and Piperacillin/tazobactam.
abstract: Concomitant vancomycin and piperacillin/tazobactam may be associated with increased acute kidney injury (AKI) compared to vancomycin without piperacillin/tazobactam. A systematic search of Medline, Cochrane Library, and Scopus through October 2016 using ["vancomycin" and "piperacillin" and "tazobactam"] and ["AKI" or "acute renal failure" or "nephrotoxicity"] and registered meta-analysis (PROSPERO: CRD42016041646) with relevant scenarios was performed. From 307 results, fourteen observational studies totaling 3549 patients were analyzed. Concomitant vancomycin and piperacillin/tazobactam was associated with AKI in unadjusted (odds ratio (OR) 3.12, 95% confidence interval (CI) 2.04-4.78) and adjusted (aOR 3.11, 95% CI 1.77-5.47) analyses. Similar findings were seen assessing studies in adults (aOR 3.15, 95% CI 1.72-5.76), children (OR 4.55, 95% CI 2.71-10.21), and when <50% of patients received care in an intensive care unit (aOR 3.04, 95% CI 1.49-6.22) but not ≥50% (aOR 2.83, 95% CI 0.74-10.85). Increased AKI with concomitant vancomycin and piperacillin/tazobactam should be considered when determining beta-lactam therapy.
authors.affiliation: University of Arkansas for Medical Sciences, College of Pharmacy, Department of Pharmacy Practice, 4301 West Markham Street, Slot 522 Little Rock, AR, USA.|University of Arkansas for Medical Sciences, Medical Center Department of Pharmacy, 4301 West Markham Street Little Rock, AR, USA.
authors.forename: Drayton A
authors.initials: DA
authors.lastname: Hammond
authors.affiliation: Medical University of South Carolina, Department of Pharmacy, 171 Ashley Avenue Charleston, SC, USA.
authors.forename: Melanie N
authors.initials: MN
authors.lastname: Smith
authors.affiliation: University of Arkansas for Medical Sciences, College of Pharmacy, Department of Pharmacy Practice, 4301 West Markham Street, Slot 522 Little Rock, AR, USA.
authors.forename: Chenghui
authors.initials: C
authors.lastname: Li
authors.affiliation: University of Minnesota Medical Center, Department of Pharmacy 2450 Riverside Avenue Minneapolis, MN, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Hayes
authors.affiliation: University of Arkansas for Medical Sciences, Medical Center Department of Pharmacy, 4301 West Markham Street Little Rock, AR, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Lusardi
authors.affiliation: College of Pharmacy at the University of South Carolina, Department of Clinical Pharmacy and Outcome Sciences, 715 Sumter Street Columbia, SC, USA.
authors.forename: P Brandon
authors.initials: PB
authors.lastname: Bookstaver
keywords: acute kidney injury; nephrotoxicity; piperacillin-tazobactam; vancomycin