The association of acute kidney injury with the concomitant use of vancomycin and piperacillin/tazobactam in children: A systematic review and meta-analysis

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

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. Out of 1381 non-duplicate studies, 10 met our inclusion criteria. We performed a random effects meta-analysis, based on crude odds ratios, 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 to have been exposed to vancomycin plus TZP, in comparison with vancomycin monotherapy (OR 8.15; 95% CI: 3.49-18.99), or vancomycin plus any other beta-lactam antibiotic (OR 3.48; 95% CI: 2.71-4.46). Based on the results of the Newcastle Ottawa Scale quality assessment, a secondary analysis including only higher quality studies (6 out of 10 studies) yielded again higher odds of exposure to vancomycin plus TZP, compared to vancomycin plus another beta-lactam antibiotic (OR 3.76; 95% CI: 2.56-5.51). Notably, even after controlling for possible publication bias our results remained statistically significant (OR 3.09; 95% CI: 2.30-4.14). 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.

Copyright © 2019 American Society for Microbiology.

Figures

FIG 1
FIG 1
Study selection flow diagram.
FIG 2
FIG 2
Meta-analysis of studies comparing vancomycin plus TZP to vancomycin plus another beta-lactam.
FIG 3
FIG 3
Meta-analysis of studies comparing vancomycin plus TZP to vancomycin monotherapy.
FIG 4
FIG 4
Meta-analysis of studies comparing vancomycin plus TZP to vancomycin plus another beta-lactam, using the “trim and fill” method for publication bias. ES, effect size (odds ratio).
FIG 5
FIG 5
Meta-analysis of only “good” quality studies comparing vancomycin plus TZP to vancomycin plus another beta-lactam.

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