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Review Article
Online Published: 30 Aug 2026
 


Piperacillin–tazobactam versus meropenem and the risk of acute kidney injury: a systematic review and meta-analysis

Sarah Ibrahim Thanoon, Anwar Ahmed Omar Khudari, Joud Mohammad Adil Ramadan, Saad Saeed Saad Alharthi, Syeda Rutaba Asad, Shaikh Muhammad Saif Ud Din, Mawaddah Mohammed Fadhil Ibrahim, Sulwan Mujahid Algain.


Abstract
Background: Acute kidney injury (AKI) is a common problem in hospitalized and critically ill patients who are treated with broad-spectrum antibiotics. 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 AKI, mortality and AKI recovery between PTZ-based and meropenem-based regimens.
Methodology: Studies that compared PTZ and meropenem and reported renal outcomes were identified through a systematic search of literature. Eighteen cohort studies were published during 2017-2025 and fulfilled the inclusion criteria and were included in the qualitative and quantitative synthesis. The Newcastle–Ottawa Scale (NOS) was used to evaluate the quality of the studies. Pooled risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. The I² statistic was used to measure heterogeneity.
Results: 37,678 patients were included in 18 studies who were treated with PTZ and 5,631 patients who were treated with meropenem. 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) and 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%). No significant difference was observed in AKI recovery rates between groups (OR = 1.18, 95% CI: 0.50–2.78, P = 0.706).
Conclusions: 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


 
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How to Cite this Article
Pubmed Style

Thanoon SI, Khudari AAO, Ramadan JMA, Alharthi SSS, Asad SR, Din SMSU, Ibrahim MMF, Algain SM. Piperacillin–tazobactam versus meropenem and the risk of acute kidney injury: a systematic review and meta-analysis. IJMDC. Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783425050

Web Style

Thanoon SI, Khudari AAO, Ramadan JMA, Alharthi SSS, Asad SR, Din SMSU, Ibrahim MMF, Algain SM. Piperacillin–tazobactam versus meropenem and the risk of acute kidney injury: a systematic review and meta-analysis. https://www.ijmdc.com/?mno=327042 [Access: August 31, 2026]. doi:10.24911/IJMDC.51-1783425050

AMA (American Medical Association) Style

Thanoon SI, Khudari AAO, Ramadan JMA, Alharthi SSS, Asad SR, Din SMSU, Ibrahim MMF, Algain SM. Piperacillin–tazobactam versus meropenem and the risk of acute kidney injury: a systematic review and meta-analysis. IJMDC. Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783425050


Vancouver/ICMJE Style

Thanoon SI, Khudari AAO, Ramadan JMA, Alharthi SSS, Asad SR, Din SMSU, Ibrahim MMF, Algain SM. Piperacillin–tazobactam versus meropenem and the risk of acute kidney injury: a systematic review and meta-analysis. IJMDC, [cited August 31, 2026]; Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783425050


Harvard Style

Thanoon, S. I., Khudari, . A. A. O., Ramadan, . J. M. A., Alharthi, . S. S. S., Asad, . S. R., Din, . S. M. S. U., Ibrahim, . M. M. F. & Algain, . S. M. (2026) Piperacillin–tazobactam versus meropenem and the risk of acute kidney injury: a systematic review and meta-analysis. IJMDC, Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783425050


Turabian Style

Thanoon, Sarah Ibrahim, Anwar Ahmed Omar Khudari, Joud Mohammad Adil Ramadan, Saad Saeed Saad Alharthi, Syeda Rutaba Asad, Shaikh Muhammad Saif Ud Din, Mawaddah Mohammed Fadhil Ibrahim, and Sulwan Mujahid Algain. 2026. Piperacillin–tazobactam versus meropenem and the risk of acute kidney injury: a systematic review and meta-analysis. International Journal of Medicine in Developing Countries, Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783425050


Chicago Style

Thanoon, Sarah Ibrahim, Anwar Ahmed Omar Khudari, Joud Mohammad Adil Ramadan, Saad Saeed Saad Alharthi, Syeda Rutaba Asad, Shaikh Muhammad Saif Ud Din, Mawaddah Mohammed Fadhil Ibrahim, and Sulwan Mujahid Algain. "Piperacillin–tazobactam versus meropenem and the risk of acute kidney injury: a systematic review and meta-analysis." International Journal of Medicine in Developing Countries Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783425050


MLA (The Modern Language Association) Style

Thanoon, Sarah Ibrahim, Anwar Ahmed Omar Khudari, Joud Mohammad Adil Ramadan, Saad Saeed Saad Alharthi, Syeda Rutaba Asad, Shaikh Muhammad Saif Ud Din, Mawaddah Mohammed Fadhil Ibrahim, and Sulwan Mujahid Algain. "Piperacillin–tazobactam versus meropenem and the risk of acute kidney injury: a systematic review and meta-analysis." International Journal of Medicine in Developing Countries Online First: 30 Aug, 2026. Web. 31 Aug 2026 doi:10.24911/IJMDC.51-1783425050


APA (American Psychological Association) Style

Thanoon, S. I., Khudari, . A. A. O., Ramadan, . J. M. A., Alharthi, . S. S. S., Asad, . S. R., Din, . S. M. S. U., Ibrahim, . M. M. F. & Algain, . S. M. (2026) Piperacillin–tazobactam versus meropenem and the risk of acute kidney injury: a systematic review and meta-analysis. International Journal of Medicine in Developing Countries, Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783425050




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