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

IF 3.8 2区医学 Q1 PHARMACOLOGY & PHARMACY

Drug Safety Pub Date : 2025-09-12 DOI:10.1007/s40264-025-01611-z

Shahd Mohammad, Haneen Ghazal, Wafaa Rahimeh, Maqsood Khan, Mosab Al Balas, Faris El-Dahiyat

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引用次数: 0

Abstract

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 I² 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; I² = 51%). No statistically significant differences were observed between groups for AKI recovery (OR 0.68; 95% CI 0.41-1.12; p = 0.13; I² = 0%) or for 30-day all-cause mortality (OR 1.34; 95% CI 0.77-2.32; p = 0.30; I² = 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.

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哌拉西林-他唑巴坦联合替柯planin与哌拉西林-他唑巴坦联合万古霉素急性肾损伤风险的比较：系统回顾和荟萃分析。

背景：哌拉西林-他唑巴坦联合万古霉素被广泛应用于广谱经验覆盖，但越来越多地与急性肾损伤（AKI）相关。用替柯planin替代万古霉素的肾脏安全性比较仍不确定。目的：本荟萃分析旨在评估哌拉西林-他唑巴坦加替柯planin （TZP-TEI）与哌拉西林-他唑巴坦加万古霉素（TZP-VAN）的肾脏预后。方法：检索PubMed、Scopus和Cochrane Central中比较住院患者TZP-TEI和TZP-VAN的研究。主要终点是AKI发生率，由肾脏疾病定义：改善总体预后（KDIGO）或RIFLE（肾功能障碍风险、肾脏损伤、肾功能衰竭或丧失和终末期肾脏疾病）标准。使用Review Manager分析数据，通过I2统计量评估异质性。结果：5项队列研究共纳入908例患者，其中4例应用倾向评分匹配（PSM），报告年龄从56.8岁到79岁不等。与TZP-VAN相比，TZP-TEI方案与AKI发生率显著降低相关（优势比[OR] 0.52； 95%可信区间[CI] 0.30-0.89; p = 0.02; I2 = 51%）。AKI恢复（OR 0.68; 95% CI 0.41-1.12; p = 0.13; I2 = 0%）和30天全因死亡率（OR 1.34; 95% CI 0.77-2.32; p = 0.30; I2 = 0%）组间无统计学差异。按AKI严重程度（KDIGO 1-3期或RIFLE标准）分层的亚组分析显示，各阶段的方向性是一致的，在PSM和非PSM队列中没有观察到显著差异。结论：TZP-TEI联合用药与AKI的发生率明显低于TZP-VAN联合用药。需要进一步的研究来验证这些发现，优化TZP-TEI组合中替柯planin的剂量，并为高危住院患者的治疗药物监测提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Drug Safety 医学-毒理学

CiteScore

7.60

自引率

7.10%

发文量

112

审稿时长

6-12 weeks

期刊介绍： Drug Safety is the official journal of the International Society of Pharmacovigilance. The journal includes: Overviews of contentious or emerging issues. Comprehensive narrative reviews that provide an authoritative source of information on epidemiology, clinical features, prevention and management of adverse effects of individual drugs and drug classes. In-depth benefit-risk assessment of adverse effect and efficacy data for a drug in a defined therapeutic area. Systematic reviews (with or without meta-analyses) that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. Original research articles reporting the results of well-designed studies in disciplines such as pharmacoepidemiology, pharmacovigilance, pharmacology and toxicology, and pharmacogenomics. Editorials and commentaries on topical issues. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Drug Safety Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.