Colistin Nephrotoxicity: Meta-Analysis of Randomized Controlled Trials.
Colistin Nephrotoxicity: Meta-Analysis of Randomized Controlled Trials.
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粘菌素肾毒性：随机对照试验的荟萃分析。
DOI：
10.1093/ofid/ofab026
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发表时间：
2021-03
影响因子：
4.2
通讯作者：
Lee TC
中科院分区：
文献类型：
--
作者：
Eljaaly K;Bidell MR;Gandhi RG;Alshehri S;Enani MA;Al-Jedai A;Lee TC
肾毒性是多粘菌素类抗生素（包括粘菌素）的已知不良反应。尽管先前的荟萃分析旨在描述与其他抗生素相关的粘菌素相关肾毒性风险，但纳入的研究本质上是观察性的，具有高混杂风险和异质性。我们对专门的随机对照试验（RCT）进行了系统性综述和荟萃分析，以评价粘菌素与最低肾毒性抗生素相关的肾毒性发生率。我们检索了PubMed、EMBASE、科克伦图书馆和3个试验登记处，寻找比较粘菌素与非多粘菌素抗生素肾毒性的随机对照试验。排除了使用氨基糖苷类的随机对照试验。使用随机效应模型计算风险比（RR）和95%置信区间（CI）。研究结局为肾毒性发生率。纳入了5项RCT，共377例患者。大多数患者在重症监护室接受粘菌素治疗肺炎，对照药物为基于β-内酰胺类药物的方案。多粘菌素E甲磺酸钠的剂量为900万单位/天（300 mg/天的粘菌素碱活性），在4项研究中给予负荷剂量。接受粘菌素治疗的患者的肾毒性发生率为36.2%（95% CI，23.3%至51.3%）。粘菌素组的肾毒性发生率显著高于对照药物组（RR，2.40; 95% CI，1.47 - 3.91; P ≤ 0.001; I2 = 0%），需要伤害的数量为5。在一项研究删除分析后，结果仍然存在。这项RCT荟萃分析发现，粘菌素相关肾毒性发生率为36.2%，与基于β-内酰胺的方案相比，该风险增加了140%。应将粘菌素视为最后一线药物，并在可能的情况下考虑更安全的替代品。在这项随机对照试验的荟萃分析中，粘菌素与36%的肾毒性发生率相关。与基于β-内酰胺的方案相比，使用粘菌素的肾毒性风险高140%。
Nephrotoxicity is a known adverse effect of polymyxin antibiotics, including colistin. Although previous meta-analyses have aimed to characterize colistin-associated nephrotoxicity risk relative to other antibiotics, included studies were observational in nature with high risk of confounding and heterogeneity. We conducted this systematic review and meta-analysis of exclusively randomized controlled trials (RCTs) to evaluate the incidence of nephrotoxicity associated with colistin versus minimally nephrotoxic antibiotics. We searched PubMed, EMBASE, Cochrane Library, and 3 trial registries for RCTs comparing the nephrotoxicity of colistin to nonpolymyxin antibiotics. Randomized controlled trials that used aminoglycosides were excluded. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. The study outcome was the rate of nephrotoxicity. Five RCTs with a total of 377 patients were included. Most patients received colistin for pneumonia in the intensive care unit, and the comparators were β-lactam-based regimens. Colistimethate sodium was dosed at 9 million units/day (300 mg/day of colistin base activity), with administration of a loading dose in 4 studies. The nephrotoxicity incidence in patients who received colistin was 36.2% (95% CI, 23.3% to 51.3%). The nephrotoxicity rate was significantly higher in the colistin arm than comparators (RR, 2.40; 95% CI, 1.47 to 3.91; P ≤ .001; I2 = 0%), and the number needed to harm was 5. Findings persisted upon one-study-removed-analysis. This meta-analysis of RCTs found a colistin-associated nephrotoxicity rate of 36.2% and an increase in this risk compared with β-lactam-based regimens by 140%. Colistin should be regarded as a last-line agent and safer alternatives should be considered when possible. In this meta-analysis of randomized controlled trials, colistin was associated with a nephrotoxicity rate of 36%. Nephrotoxicity risk was 140% higher with colistin compared to a beta-lactam-based regimen.
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影响因子：
4.1
作者：
Tsuji, Brian T.;Pogue, Jason M.;Kaye, Keith S.
通讯作者：
Kaye, Keith S.
影响因子：
15.1
作者：
Cisneros, Jose M.;Maria Rosso-Fernandez, Clara;Vidal, P.
通讯作者：
Vidal, P.
DOI：
10.1016/j.diagmicrobio.2018.11.008
发表时间：
2019-05-01
影响因子：
2.9
作者：
Oliota, Ana F.;Penteado, Suelem T.;Sanches, Andreia C.
通讯作者：
Sanches, Andreia C.
影响因子：
3.7
作者：
Shields, Ryan K.;Anand, Rohit;Bonilla, Hector
通讯作者：
Bonilla, Hector
影响因子：
11.8
作者：
Motsch, Johann;de Oliveira, Claudia Murta;Paschke, Amanda
通讯作者：
Paschke, Amanda