Incidence and predictors of acute kidney injury associated with intravenous polymyxin B therapy
Incidence and predictors of acute kidney injury associated with intravenous polymyxin B therapy
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DOI：
10.1016/j.jinf.2012.01.015
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发表时间：
2012-07-01
影响因子：
28.2
通讯作者：
Yin, Michael T.
中科院分区：
文献类型：
--
作者：
Kubin, Christine J.;Ellman, Tanya M.;Yin, Michael T.
背景：革兰氏阴性菌多药耐药性的增加使得多粘菌素的使用成为必要。到目前为止，与多粘菌素B相关的急性肾损伤（阿基）的发生率尚未使用步枪criteria.Methods进行评估：回顾性评估接受多粘菌素B治疗的成人患者，以确定使用步枪标准进行多粘菌素B治疗期间阿基的发生率。通过比较AKI患者和非阿基患者的特征来确定阿基的预测因素。阿基的发生率为60%。10例（14%）患者因肾毒性而停止治疗。多粘菌素B的中位持续时间为11天，中位累积剂量为18 mg/kg。69例患者（95%）接受了伴随肾毒素治疗。与未发生阿基的患者相比，AKI患者的中位累积剂量更高（1578 mg vs. 800 mg; p = 0.02），体重指数（BMI）更高（27.2 vs. 24.5 kg/m2; p = 0.03），更可能接受万古霉素治疗（82% vs. 55%; p = 0.03）。在控制了多粘菌素B的使用时间后，阿基的独立预测因素是较高的BMI和伴随使用万古霉素。结论：多粘菌素B治疗期间阿基的发生率为60%。需要进一步的研究来确定最大化疗效和最小化肾毒性的给药参数。(C)2012年，英国传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Background: Increases in multidrug-resistance among gram-negative organisms have necessitated the use of polymyxins. To date, the incidence of acute kidney injury (AKI) associated with polymyxin B has not been evaluated using RIFLE criteria.Methods: Adult patients who received polymyxin B were retrospectively evaluated to determine the incidence of AKI during polymyxin B therapy using RIFLE criteria. Predictors of AKI were identified by comparing characteristics of patients with and without AKI.Results: A total of 73 patients were included. The incidence of AKI was 60%. Ten (14%) patients discontinued therapy due to nephrotoxicity. Median duration of polymyxin B was 11 days with a median cumulative dose of 18 mg/kg. Concomitant nephrotoxins were received in 69 (95%). Patients with AKI had a higher median cumulative dose (1578 mg vs. 800 mg; p = 0.02), a higher body mass index (BMI) (27.2 vs. 24.5 kg/ m(2); p = 0.03), and were more likely to receive vancomycin (82% vs. 55%; p = 0.03) compared to those without AKI. After controlling for polymyxin B duration, independent predictors of AKI were higher BMI and concomitant vancomycin.Conclusions: The incidence of AKI during polymyxin B therapy was 60%. Further studies are needed to define dosing parameters that maximize efficacy and minimize nephrotoxicity. (C) 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.