Risk factors for kidney injury during vancomycin and piperacillin/tazobactam administration, including increased odds of injury with combination therapy.
Risk factors for kidney injury during vancomycin and piperacillin/tazobactam administration, including increased odds of injury with combination therapy.
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DOI：
10.1186/s13104-015-1518-9
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发表时间：
2015-10-17
影响因子：
1.8
通讯作者：
Anderson, Albert M
中科院分区：
文献类型：
--
作者：
Kim, Tiffany;Kandiah, Sheetal;Anderson, Albert M
背景：急性肾损伤(AKI)常见于住院患者，并与某些药物的使用有关。最近有报道指出，万古霉素和哌拉西林/他唑巴坦(联合用药/他唑巴坦)联合用药可能比单一用药更容易引起急性肾功能衰竭。方法：对城市某大型教学医院的非危重住院患者进行了一项回顾性研究，比较两种药物联合用药和单用两种药物治疗急性肾功能衰竭的发生率和危险因素。AKI被定义为：(1)血清肌酐≥升高0.50 mg/dl或(2)≥较入院基线升高1.5倍。除了标准的多变量回归调整外，在估计AKI的调整优势时，倾向分数加权被用作一种稳健的方法来减少协变量混杂的影响。结果：总共评估了228名患者。AKI的总发生率为11.8%(228例患者中27例)。VANC组101例患者中发生急性心肌梗死4例(4.0%)，吡他唑组26例患者中发生急性心肌梗死4例(15.4%)，V/P联合组101例患者中发生急性心肌梗死19例(18.8%)。与合并V/P组(OR 0.178，95%CI 0.058~0.544，p=0.003)和吡他唑组(OR 0.227，95%CI 0.053~0.978，p=0.047)相比，VANC组发生急性心肌梗死的单变量优势显著降低。解释基线特征的多变量模型再次显示，单一VANC治疗急性心肌梗死的几率低于联合V/P治疗(OR0.14，95%CI0.04-0.52，p=0.004)。在多变量模型中，男性与AKI的相对危险度较低(OR为0.28，95%CI为0.10~0.79，p=0.02)。在使用逆治疗概率加权的倾向评分分析中，单一VANC治疗和男性性别再次与较低的急性心肌梗死风险相关(OR0.17；95%CI0.04~0.62，p=0.008和OR0.28，95%CI0.09~0.89，p=0.03)。结论：本研究证实了最近的报道，在住院患者中，合并V/P可能比VANC单一治疗更容易发生急性KI。在使用这些抗菌剂治疗期间，Aki似乎更有可能出现在女性身上。虽然疾病的严重程度很难解释，但在住院患者开始使用抗生素后，这些发现进一步证明了在可能的情况下缩小抗生素覆盖面的理由。
BACKGROUND: Acute kidney injury (AKI) occurs frequently in hospitalized patients and has been associated with the administration of certain medications. Concerns have been raised in recent reports that the antibiotic combination of vancomycin and piperacillin/tazobactam (combV/P) may be more associated with AKI than monotherapy with either drug.METHODS: To compare the incidence of and risk factors for AKI in patients receiving combV/P versus monotherapy with either drug, a retrospective study was conducted in non-critically ill inpatients at a large urban teaching hospital. AKI was defined as either: (1) Increase in serum creatinine ≥0.5 mg/dl OR (2) ≥1.5-fold creatinine increase from admission baseline. In addition to standard multivariable regression adjustment, propensity score weighting was used as a robust approach to reduce the effects of covariate confounding when estimating the adjusted odds of AKI.RESULTS: A total of 228 patients were evaluated. The overall incidence of AKI was 11.8 % (27 of 228 patients). AKI occurred in 4 of 101 patients in the vanc group (4.0 %), 4 of 26 patients in the piptazo group (15.4 %), and 19 of 101 patients in the combV/P group (18.8 %). The univariable odds of AKI was significantly lower in the vanc group compared to both the combV/P group (OR 0.178, 95 % CI 0.058-0.544, p = 0.003) and piptazo (OR 0.227, 95 % CI 0.053-0.978, p = 0.047) group. A multivariable model accounting for baseline characteristics again showed that vanc monotherapy was associated with lower odds of AKI than combV/P (OR 0.14, 95 % CI 0.04-0.52, p = 0.004). Male sex was also associated with lower odds of AKI (OR 0.28, 95 % CI 0.10-0.79, p = 0.02) in the multivariable model. In the propensity score analysis using inverse probability of treatment weighting (IPTW), vanc monotherapy and male sex were again associated with lower odds of AKI (OR 0.17; 95 % CI 0.04-0.62, p = 0.008 and OR 0.28, 95 % CI 0.09-0.89, p = 0.03, respectively).CONCLUSION: This study substantiates recent reports that combV/P may be more associated with AKI than vanc monotherapy in hospital inpatients. AKI also appears to be more likely in females during therapy with these antimicrobials. While severity of illness is difficult to account for, these findings are further justification for narrowing antibiotic coverage when possible after this combination has been initiated in hospitalized patients.