Abstract

Piperacillin-tazobactam (PTZ) and meropenem are two antibiotics that are frequently used to treat severe infections, but questions have been raised about the potential for nephrotoxicity of PTZ, especially when combined with vancomycin. The objective of this systematic review and meta-analysis was to compare the risk of acute kidney injury (AKI), mortality, and AKI recovery between PTZ-based and meropenem-based regimens. Eighteen cohort studies were published during 2017-2025, fulfilled the inclusion criteria, and were included in the qualitative and quantitative synthesis. Pooled risk ratios (RRs) and odds ratios with 95% confidence intervals (CIs) were calculated using random-effects models. A total of 37,678 patients who were treated with PTZ and 5,631 patients who were treated with meropenem were included in 18 studies. Meta-analysis revealed that there was a significantly higher risk of AKI associated with PTZ than meropenem (RR = 1.65, 95% CI: 1.37 2.00, p < 0.0001) with significant heterogeneity between studies (I² = 74.3%). The rates of AKI were 15.0% in the PTZ group and 13.8% in the meropenem group. There was significantly less mortality in patients receiving PTZ compared with those receiving meropenem (RR = 0.77, 95% CI: 0.62-0.95, p = 0.017), with low-to-moderate heterogeneity (I² = 43.5%). PTZ was significantly more likely to be associated with an AKI than meropenem but was not associated with higher mortality and similar rates of recovery from AKI. Renal monitoring should be considered during PTZ therapy, especially in high-risk patients, in the context of antimicrobial effectiveness and stewardship issues.

Key words: Piperacillin–Tazobactam, Meropenem, Acute Kidney Injury, Systematic Review and Meta-Analysis