Trimethoprim use for urinary tract infection and risk of adverse outcomes in older patients: cohort study.
Trimethoprim use for urinary tract infection and risk of adverse outcomes in older patients: cohort study.
复制标题
DOI：
10.1136/bmj.k341
复制
发表时间：
2018-02-09
期刊：
影响因子：
--
通讯作者：
Tomlinson LA
中科院分区：
文献类型：
--
作者：
Crellin E;Mansfield KE;Leyrat C;Nitsch D;Douglas IJ;Root A;Williamson E;Smeeth L;Tomlinson LA
确定甲氧苄啶用于尿路感染（UTI）是否与普通人群中急性肾损伤、高钾血症或猝死风险增加相关。队列研究。英国电子初级保健记录的做法，有助于临床实践研究数据链接到医院事件统计数据库。1997年4月至2015年9月期间，在初级保健诊断为UTI后3天内处方甲氧苄啶、阿莫西林、头孢氨苄、环丙沙星或呋喃妥因的65岁及以上成人。结果为急性肾损伤、高钾血症和UTI抗生素治疗后14天内死亡。在1191905例65岁及以上患者中，确定了178238例患者至少有一次接受抗生素治疗的UTI，共包括422514例接受抗生素治疗的UTI。与阿莫西林相比，甲氧苄啶（调整后的比值比1.72，95%置信区间1.31至2.24）和环丙沙星（1.48，1.03至2.13）在抗生素开始后14天内发生急性肾损伤的几率更高。开始使用抗生素后14天内高钾血症的几率仅在甲氧苄啶组高于阿莫西林组（2.27，1.49 - 3.45）。然而，甲氧苄啶组在开始使用抗生素后14天内的死亡几率并不高于阿莫西林组：在整个人群中，调整后的比值比为0.90（95%置信区间为0.76至1.07），而在使用肾素-血管紧张素系统阻滞剂的人群中，在开始使用抗生素后14天内的死亡几率为1.12（0.80至1.57）。结果表明，对于65岁及以上人群中接受抗生素治疗的1000例尿路感染，使用甲氧苄啶而不是阿莫西林治疗将导致1至2例高钾血症和2例急性肾损伤，无论是否阻断肾素-血管紧张素系统。然而，对于服用肾素-血管紧张素系统阻滞剂和螺内酯治疗的人，用甲氧苄啶代替阿莫西林，另外有18例高钾血症和11例急性肾损伤。与用于治疗UTI的其他抗生素相比，甲氧苄啶与急性肾损伤和高钾血症的风险更大相关，但死亡风险并不更大。各人群的相对风险增加相似，但服用肾素-血管紧张素系统阻滞剂和保钾利尿剂的患者基线风险较高，转化为这些人群中急性肾损伤和高钾血症的绝对风险较高。
To determine if trimethoprim use for urinary tract infection (UTI) is associated with an increased risk of acute kidney injury, hyperkalaemia, or sudden death in the general population. Cohort study. UK electronic primary care records from practices contributing to the Clinical Practice Research Datalink linked to the Hospital Episode Statistics database. Adults aged 65 and over with a prescription for trimethoprim, amoxicillin, cefalexin, ciprofloxacin, or nitrofurantoin prescribed up to three days after a primary care diagnosis of UTI between April 1997 and September 2015. The outcomes were acute kidney injury, hyperkalaemia, and death within 14 days of a UTI treated with antibiotics. Among a cohort of 1 191 905 patients aged 65 and over, 178 238 individuals were identified with at least one UTI treated with antibiotics, comprising a total of 422 514 episodes of UTIs treated with antibiotics. The odds of acute kidney injury in the 14 days following antibiotic initiation were higher following trimethoprim (adjusted odds ratio 1.72, 95% confidence interval 1.31 to 2.24) and ciprofloxacin (1.48, 1.03 to 2.13) compared with amoxicillin. The odds of hyperkalaemia in the 14 days following antibiotic initiation were only higher following trimethoprim (2.27, 1.49 to 3.45) compared with amoxicillin. However, the odds of death within the 14 days following antibiotic initiation were not higher with trimethoprim than with amoxicillin: in the whole population the adjusted odds ratio was 0.90 (95% confidence interval 0.76 to 1.07) while among users of renin-angiotensin system blockers the odds of death within 14 days of antibiotic initiation was 1.12 (0.80 to 1.57). The results suggest that, for 1000 UTIs treated with antibiotics among people 65 and over, treatment with trimethoprim instead of amoxicillin would result in one to two additional cases of hyperkalaemia and two admissions with acute kidney injury, regardless of renin-angiotensin system blockade. However, for people taking renin-angiotensin system blockers and spironolactone treatment with trimethoprim instead of amoxicillin there were 18 additional cases of hyperkalaemia and 11 admissions with acute kidney injury. Trimethoprim is associated with a greater risk of acute kidney injury and hyperkalaemia compared with other antibiotics used to treat UTIs, but not a greater risk of death. The relative risk increase is similar across population groups, but the higher baseline risk among those taking renin-angiotensin system blockers and potassium-sparing diuretics translates into higher absolute risks of acute kidney injury and hyperkalaemia in these groups.
登录
查看更多内容
影响因子：
5.2
作者：
Fraser, Traci Nicole;Avellaneda, Andres A.;Musher, Daniel M.
通讯作者：
Musher, Daniel M.
影响因子：
3.4
作者：
Chan, Wei Yee;Clark, Allan B.;Loke, Yoon K.
通讯作者：
Loke, Yoon K.
影响因子：
2.9
作者：
Gentry, Chris A.;Nguyen, Ann T.
通讯作者：
Nguyen, Ann T.
影响因子：
4.2
作者：
Alappan, R;Buller, GK;Perazella, MA
通讯作者：
Perazella, MA
影响因子：
39.2
作者：
Levey AS;Stevens LA;Schmid CH;Zhang YL;Castro AF 3rd;Feldman HI;Kusek JW;Eggers P;Van Lente F;Greene T;Coresh J;CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)