Kidney Week

Abstract: FR-PO0116

Risk of AKI Associated with Vancomycin in Combination with Other Broad-Spectrum Antipseudomonal Antibiotics: Systematic Review and Meta-Analysis

Session Information

• AKI: Epidemiology and Clinical Trials
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Gonzalez Flores, Paulina L, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Paulina L Gonzalez Flores, MD

• Ameer, Muhammad Zain, King Edward Medical University, Lahore, Punjab, Pakistan

Muhammad Zain Ameer, MBBS

• Rehman, Aqeeb Ur, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Aqeeb Ur Rehman, MBBS, MD

• Renzi, Stefania, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Stefania Renzi, MD

• Ekrikpo, Udeme E., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Udeme E. Ekrikpo, MBBS, MS, PhD

• Abeer, Huzaifa, King Edward Medical University, Lahore, Punjab, Pakistan

Huzaifa Abeer, MBBS

• Mahmood, Ghulam Mustafa, King Edward Medical University, Lahore, Punjab, Pakistan

Ghulam Mustafa Mahmood, MD, MBBS

• Rehman, Ghazia, King Edward Medical University, Lahore, Punjab, Pakistan

Ghazia Rehman, MBBS

• Ameer, Fatima, Holy Family Hospital, Rawalpindi, Punjab, Pakistan

Fatima Ameer, MBBS

• Tolwani, Ashita J., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Ashita J. Tolwani, MD, MS, MSc, FASN

• Neyra, Javier A., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Javier A. Neyra, MD, MS, FASN

Background

In hospitalized patients with infections, vancomycin (VAN) is often combined with broad-spectrum antipseudomonal antibiotics (BSAs), but the risk for acute kidney injury (AKI) associated with these combinations has not been comprehensively evaluated in previous meta-analyses.

Methods

A systematic search of PubMed/MEDLINE, CENTRAL, EMBASE, and Scopus was conducted to identify studies comparing AKI incidence, severity, and outcomes across VAN-containing combinations from inception to April 15, 2025. Two reviewers independently screened articles for eligibility and discrepancies were resolved by a third reviewer. DerSimonian-Laird random effects meta-analysis was undertaken. Outcomes were stratified by drug combinations and patient populations (ICU vs. non-ICU, pediatric vs. adult). Risk of bias was assessed using Newcastle-Ottawa Scale (NOS) across three criteria: patient selection, comparability and outcomes. All analyses were conducted using RevMan version 5.4.

Results

A total of 89 studies, involving 162,192 hospitalized patients were included in the quantitative synthesis, with 62.5% receiving VAN-piperacillin/tazobactam (PTZ), 25.3% VAN-cefepime, 7.4% VAN-carbapenems, 1.6% VAN-other BSAs and 3.2% VAN only. VAN-PTZ was associated with higher risk of AKI compared to all other combinations: OR=2.13, 95% CI 1.77-2.57, I²=70% vs. VAN-carbapenems; OR=1.98, 95% CI 1.74-2.25, I²=78% vs. VAN-cefepime; OR=2.42, 95% CI 1.95-2.99, I²=50% vs. VAN-other BSAs, and also when compared to VAN alone (OR=3.06, 95% CI 2.60-3.60, I²=16%). This effect was consistent across all stages of AKI, age groups (adult and pediatric), and in both ICU and non-ICU populations. In contrast, VAN-PTZ did not differentially affect RRT need or in-hospital mortality when compared to other VAN combinations or VAN alone.

Conclusion

VAN-PTZ is a common antibiotic combination to treat infections in hospitalized patients that was associated with a higher risk of AKI. Studies are needed to characterize whether the observed AKI is directly attributable to a nephrotoxic effect of VAN-PTZ and to identify high-risk patient phenotypes suitable for nephroprotective interventions.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025tc041868