Acute kidney injury and vancomycin/piperacillin/tazobactam in adult patients: a systematic review

Intern Emerg Med. 2020 Mar;15(2):327-331. doi: 10.1007/s11739-020-02287-2. Epub 2020 Feb 10.


The aim of this systematic review was to assess AKI (acute kidney injury) in adult patients, treated with vancomycin (V) + piperacillin/tazobactam (PT) compared to V monotherapy. Studies were found in Pubmed, Web of Science and Scopus databases. Articles not in English, pediatric studies and case reports were excluded. A study is eligible for inclusion if the adjusted Odds ratio (aOR) for AKI in V + PT compared to V monotherapy groups, could be extracted or determined from available data. Six retrospective cohort studies were eligible for inclusion criteria and so they were included in the analysis. All studies separately showed a significant higher risk of developing AKI (OR > 1, p < 0.05) in V + PT group compared to V monotherapy group. Considering the methodological difference of included studies, a random effect model was preferred. The model showed a pooled significant higher risk of developing AKI [OR 2.77 (95% CI 1.94, 3.96), p < 0.0001] in V + PT group compared to V group. Association of V and PT appears to be associated with a greater risk of AKI compared to V in monotherapy. These results may serve as the impetus for further evaluation into true mechanisms behind this additive nephrotoxic effect and its potential implications on mortality.

Keywords: Acute kidney injury; Adult patients; Piperacillin/tazobactam; Vancomycin.

Publication types

  • Systematic Review

MeSH terms

  • Acute Kidney Injury / etiology*
  • Adult
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use
  • Drug Therapy, Combination / adverse effects
  • Drug Therapy, Combination / standards*
  • Humans
  • Piperacillin / adverse effects*
  • Piperacillin / therapeutic use
  • Tazobactam / adverse effects*
  • Tazobactam / therapeutic use
  • Vancomycin / adverse effects*
  • Vancomycin / therapeutic use


  • Anti-Bacterial Agents
  • Vancomycin
  • Tazobactam
  • Piperacillin