Factors associated with vancomycin nephrotoxicity in the critically ill
Factors associated with vancomycin nephrotoxicity in the critically ill
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DOI：
10.1177/0310057x1504300507
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发表时间：
2015-09-01
影响因子：
1.5
通讯作者：
Udy, A.
中科院分区：
文献类型：
--
作者：
Hanrahan, T. P.;Kotapati, C.;Udy, A.
万古霉素是一种糖肽类抗生素，常用于治疗耐甲氧西林金黄色葡萄球菌感染。最近耐甲氧西林金黄色葡萄球菌的流行增加，并降低了对万古霉素的敏感性，这促使专家们倡导更高的目标血药浓度。这项研究旨在评估更积极的万古霉素治疗的潜在后果，通过检测危重患者人群中较高的血清浓度与急性肾损伤(AKI)之间的关系。我们收集了所有在五年期间接受万古霉素治疗的患者的数据，并使用风险、损伤、衰竭、丢失和终末期(RIFLE)肾脏疾病标准评估了新发AKI的患病率。159名患者提供了完整的数据，8.8%的患者在接受万古霉素治疗时表现出新的急性肾损伤。多因素Logistic回归分析显示，平均血谷浓度(OR=1.174，P=0.024)、APACHE II评分(OR=1.141，P=0.012)和同时开氨基糖苷类药物(OR=18.896，P=0.002)是急性脑梗塞的重要预测因素。这些数据表明，危重患者的万古霉素血药浓度谷值越高，发生AKI的几率越大。
Vancomycin is a glycopeptide antibiotic commonly used in the management of methicillin-resistant Staphylococcus aureus infection. The recent increase in prevalence of methicillin-resistant Staphylococcus aureus with reduced susceptibility to vancomycin has prompted experts to advocate for higher target trough serum concentrations. This study aimed to evaluate the potential consequences of more aggressive vancomycin therapy, by examining the association between higher serum concentrations and acute kidney injury (AKI) in a population of critically ill patients. We collected data for all patients who received vancomycin over a five-year period and evaluated the prevalence of new-onset AKI using the Risk, Injury, Failure, Loss and End-stage (RIFLE) kidney disease criteria. One-hundred and fifty-nine patients provided complete data, with 8.8% manifesting new onset AKI while receiving vancomycin. The median age was 57 (44 to 68) years, while the median trough serum concentration was 16 (10 to 19) mg/l. Multivariate logistic regression analysis identified mean trough concentration (OR=1.174, P=0.024), APACHE II score (OR=1.141, P=0.012) and simultaneous aminoglycoside prescription (OR=18.896, P=0.002) as significant predictors of AKI. These data suggest higher trough vancomycin serum concentrations are associated with greater odds of AKI in the critically ill.