Effect of serum concentration and concomitant drugs on vancomycin-induced acute kidney injury in haematologic patients: a single-centre retrospective study
Effect of serum concentration and concomitant drugs on vancomycin-induced acute kidney injury in haematologic patients: a single-centre retrospective study
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血液病患者血清浓度及合并用药对万古霉素所致急性肾损伤的影响：单中心回顾性研究
DOI：
10.1007/s00228-019-02756-4
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发表时间：
2019
影响因子：
2.9
通讯作者：
Ishizawa K
中科院分区：
文献类型：
--
作者：
Okada N;Chuma M;Azuma M;Nakamura S;Miki H;Hamano H;Goda M;Takechi K;Zamami Y;Abe M;Ishizawa K
目的万古霉素（vancomycin，VCM）的合理应用是预防急性肾损伤（acute kidney injury，阿基）的重要措施.由于VCM用于治疗发热性中性粒细胞减少症的频率较高，并且伴随使用其他肾毒性药物，因此血液病患者与其他疾病患者相比具有不同的肾毒性背景。因此，尚不清楚在其他患者组中确定的VCM诱导阿基的风险因素是否也适用于血液病患者。在此，我们进行了单中心的回顾性分析，以确定与VCM诱导的阿基在haematologicpatients.MethodsWe回顾性分析了150名血液病患者，其中VCM是管理在2010年4月至2018年3月在德岛大学医院。VCM诱导的阿基根据肾脏疾病改善全球结局（KDIGO）标准定义。进行多变量Logistic回归分析，以确定VCM诱导阿基的危险因素。多因素分析显示，VCM诱导的阿基的风险因素为初始VCM谷浓度> 15 mg/L以及合并使用他唑巴坦/哌拉西林（TAZ/PIPC）和脂质体阿替西汀B（L-AMB）。初始VCM谷浓度< 10 mg/L的患者对发热性中性粒细胞减少症的疗效显著降低。有趣的是，伴随使用L-AMB的VCM浓度依赖性的方式增加的VCM诱导的阿基的发病率，而伴随TAZ/PIPC增加的发病率在VCM concentration-independent martens.ConclusionsThe最佳初始VCM谷浓度为10-15 mg/L的血液病患者，考虑到安全性和有效性。肾毒性药物对VCM诱导的阿基的影响存在差异。
PurposeAppropriate use of vancomycin (VCM) is important in preventing acute kidney injury (AKI). Because of the high frequency of VCM use for febrile neutropenia and concomitant use of other nephrotoxic drugs, haematologic patients have a different nephrotoxic background compared with patients with other diseases. Therefore, it is unclear whether the risk factors of VCM-induced AKI identified in other patient groups are also applicable to haematologic patients. Herein, we performed a single-centre retrospective analysis to identify the factors associated with VCM-induced AKI in haematologic patients.MethodsWe retrospectively analysed 150 haematologic patients to whom VCM was administered between April 2010 and March 2018 at Tokushima University Hospital. VCM-induced AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Multivariate logistic regression analyses were performed to identify risk factors for VCM-induced AKI.ResultsSeventeen patients had VCM-induced AKI. Multivariate analysis revealed that the risk factors of VCM-induced AKI were an initial VCM trough concentration of > 15 mg/L and concomitant use of tazobactam/piperacillin (TAZ/PIPC) and liposomal amphotericin B (L-AMB). Patients with an initial VCM trough concentration of < 10 mg/L showed significantly lower efficacy in febrile neutropenia. Interestingly, concomitant L-AMB use increased the incidence of VCM-induced AKI in a VCM concentration–dependent manner, whereas concomitant TAZ/PIPC increased the incidence in a VCM concentration–independent manner.ConclusionsThe optimal initial VCM trough concentration was 10–15 mg/L in haematologic patients, considering safety and effectiveness. There were differences in the effect of VCM-induced AKI between nephrotoxic drugs.