PDF(Pubmed)
Abstract：
Evidence regarding acute kidney injury associated with concomitant administration of vancomycin and piperacillin-tazobactam is conflicting, particularly in patients in the ICU.
Does a difference exist in the association between commonly prescribed empiric antibiotics on ICU admission (vancomycin and piperacillin-tazobactam, vancomycin and cefepime, and vancomycin and meropenem) and acute kidney injury?
This was a retrospective cohort study using data from the eICU Research Institute, which contains records for ICU stays between 2010 and 2015 across 335 hospitals. Patients were enrolled if they received vancomycin and piperacillin-tazobactam, vancomycin and cefepime, or vancomycin and meropenem exclusively. Patients initially admitted to the ED were included. Patients with hospital stay duration of < 1 h, receiving dialysis, or with missing data were excluded. Acute kidney injury was defined as Kidney Disease: Improving Global Outcomes stage 2 or 3 based on serum creatinine component. Propensity score matching was used to match patients in the control (vancomycin and meropenem or vancomycin and cefepime) and treatment (vancomycin and piperacillin-tazobactam) groups, and ORs were calculated. Sensitivity analyses were performed to study the effect of longer courses of combination therapy and patients with renal insufficiency on admission.
Thirty-five thousand six hundred fifty-four patients met inclusion criteria (vancomycin and piperacillin-tazobactam, n = 27,459; vancomycin and cefepime, n = 6,371; vancomycin and meropenem, n = 1,824). Vancomycin and piperacillin-tazobactam was associated with a higher risk of acute kidney injury and initiation of dialysis when compared with that of both vancomycin and cefepime (Acute kidney injury: OR, 1.37 [95% CI, 1.25-1.49]; dialysis: OR, 1.28 [95% CI, 1.14-1.45]) and vancomycin and meropenem (Acute kidney injury: OR, 1.27 [95%, 1.06-1.52]; dialysis: OR, 1.56 [95% CI, 1.23-2.00]). The odds of acute kidney injury developing was especially pronounced in patients without renal insufficiency receiving a longer duration of vancomycin and piperacillin-tazobactam therapy compared with vancomycin and meropenem therapy.
VPT is associated with a higher risk of acute kidney injury than both vancomycin and cefepime and vancomycin and meropenem in patients in the ICU, especially for patients with normal initial kidney function requiring longer durations of therapy. Clinicians should consider vancomycin and meropenem or vancomycin and cefepime to reduce the risk of nephrotoxicity for patients in the ICU.
Does a difference exist in the association between commonly prescribed empiric antibiotics on ICU admission (vancomycin and piperacillin-tazobactam, vancomycin and cefepime, and vancomycin and meropenem) and acute kidney injury?
This was a retrospective cohort study using data from the eICU Research Institute, which contains records for ICU stays between 2010 and 2015 across 335 hospitals. Patients were enrolled if they received vancomycin and piperacillin-tazobactam, vancomycin and cefepime, or vancomycin and meropenem exclusively. Patients initially admitted to the ED were included. Patients with hospital stay duration of < 1 h, receiving dialysis, or with missing data were excluded. Acute kidney injury was defined as Kidney Disease: Improving Global Outcomes stage 2 or 3 based on serum creatinine component. Propensity score matching was used to match patients in the control (vancomycin and meropenem or vancomycin and cefepime) and treatment (vancomycin and piperacillin-tazobactam) groups, and ORs were calculated. Sensitivity analyses were performed to study the effect of longer courses of combination therapy and patients with renal insufficiency on admission.
Thirty-five thousand six hundred fifty-four patients met inclusion criteria (vancomycin and piperacillin-tazobactam, n = 27,459; vancomycin and cefepime, n = 6,371; vancomycin and meropenem, n = 1,824). Vancomycin and piperacillin-tazobactam was associated with a higher risk of acute kidney injury and initiation of dialysis when compared with that of both vancomycin and cefepime (Acute kidney injury: OR, 1.37 [95% CI, 1.25-1.49]; dialysis: OR, 1.28 [95% CI, 1.14-1.45]) and vancomycin and meropenem (Acute kidney injury: OR, 1.27 [95%, 1.06-1.52]; dialysis: OR, 1.56 [95% CI, 1.23-2.00]). The odds of acute kidney injury developing was especially pronounced in patients without renal insufficiency receiving a longer duration of vancomycin and piperacillin-tazobactam therapy compared with vancomycin and meropenem therapy.
VPT is associated with a higher risk of acute kidney injury than both vancomycin and cefepime and vancomycin and meropenem in patients in the ICU, especially for patients with normal initial kidney function requiring longer durations of therapy. Clinicians should consider vancomycin and meropenem or vancomycin and cefepime to reduce the risk of nephrotoxicity for patients in the ICU.
摘要：
背景：关于与万古霉素和哌拉西林/他唑巴坦（VPT）同时给药相关的急性肾损伤（AKI）存在矛盾的证据，特别是重症监护病房（ICU）患者。
目的：入住ICU时常用经验性抗生素（VPT，万古霉素和头孢吡肟[VC]，和万古霉素和美罗培南[VM]）和AKI？
方法：本研究是一项回顾性队列研究，使用eICU研究所（eRI）的数据，其中包含2010年至2015年期间335家医院的ICU住院记录。如果患者接受VPT，VC,或VM独占。包括最初进入急诊科的患者。住院时间<1h的患者，透析时，或缺失的数据被排除。基于血清肌酐组分,AKI被定义为KDIGO阶段2或3。倾向评分匹配用于匹配对照（VM或VC）和治疗患者（VPT），并计算了比值比。进行了敏感性分析，以研究更长疗程的联合治疗和肾功能不全患者对入院的影响。
结果：35,654例患者符合纳入标准（VPTn=27,459；VCn=6,371；VMn=1,824）。与两种VC相比，VPT发生AKI和开始透析的风险更高(AKI：OR，1.37；95%CI，1.25-1.49；透析：OR，1.28；95%CI，1.14-1.45）和VM（AKI：或，1.27；95%，1.06-1.52；透析：或，1.56；95%CI，1.23-2.00）。与VM相比，没有肾功能不全的患者接受更长持续时间的VPT治疗，发生AKI的几率尤其明显。
结论：在ICU患者中，VPT与AKI的风险高于VC和VM，特别是对于初始肾功能正常的患者，需要更长的治疗时间。临床医生应考虑VM或VC，以降低ICU患者肾毒性的风险。
目的：入住ICU时常用经验性抗生素（VPT，万古霉素和头孢吡肟[VC]，和万古霉素和美罗培南[VM]）和AKI？
方法：本研究是一项回顾性队列研究，使用eICU研究所（eRI）的数据，其中包含2010年至2015年期间335家医院的ICU住院记录。如果患者接受VPT，VC,或VM独占。包括最初进入急诊科的患者。住院时间<1h的患者，透析时，或缺失的数据被排除。基于血清肌酐组分,AKI被定义为KDIGO阶段2或3。倾向评分匹配用于匹配对照（VM或VC）和治疗患者（VPT），并计算了比值比。进行了敏感性分析，以研究更长疗程的联合治疗和肾功能不全患者对入院的影响。
结果：35,654例患者符合纳入标准（VPTn=27,459；VCn=6,371；VMn=1,824）。与两种VC相比，VPT发生AKI和开始透析的风险更高(AKI：OR，1.37；95%CI，1.25-1.49；透析：OR，1.28；95%CI，1.14-1.45）和VM（AKI：或，1.27；95%，1.06-1.52；透析：或，1.56；95%CI，1.23-2.00）。与VM相比，没有肾功能不全的患者接受更长持续时间的VPT治疗，发生AKI的几率尤其明显。
结论：在ICU患者中，VPT与AKI的风险高于VC和VM，特别是对于初始肾功能正常的患者，需要更长的治疗时间。临床医生应考虑VM或VC，以降低ICU患者肾毒性的风险。
