A propensity-matched cohort study of vancomycin-associated nephrotoxicity in neonates
A propensity-matched cohort study of vancomycin-associated nephrotoxicity in neonates
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DOI：
10.1136/archdischild-2015-308459
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发表时间：
2016-05-01
影响因子：
4.4
通讯作者：
Spigarelli, Michael G.
中科院分区：
文献类型：
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作者：
Constance, Jonathan E.;Balch, Alfred H.;Spigarelli, Michael G.
背景万古霉素治疗的新生儿肾毒性发生率据报道为2% - 20%。这些差异很大的估计导致了关于万古霉素在新生儿中的安全性的困惑和争议。目的评价万古霉素与庆大霉素合用新生儿肾毒性的发生率。设计回顾性观察队列研究，使用倾向评分匹配，根据已知与肾功能发展相关的因素，在接受或未接受万古霉素治疗的新生儿之间提供协变量平衡。整个西部山间地区的医院（n=22），包括一家四级护理儿童医院。2006年1月至2012年12月接受静脉注射庆大霉素的新生儿（中位胎龄：31 （IQR 28-36）周），有或没有接触万古霉素。主要观察指标为肾毒性，基于修改后的急性肾损伤网络标准（AKI）或血清肌酐浓度1.5mg/dL持续48小时。结果最终队列由1066名新生儿组成（533名接受万古霉素和庆大霉素治疗，533名接受庆大霉素治疗）。在一个倾向评分匹配的队列中，16个变量之间平衡良好，AKI与万古霉素的使用无关（接受万古霉素治疗的16名新生儿与7名对照组发生AKI； OR为1.5；95% CI为0.6至4.0）。然而，动脉导管未闭、同时使用非甾体抗炎药、1阳性血培养、低出生体重、较高的疾病严重程度和死亡风险评分与肾毒性风险增加相关。结论：这些结果证实了一些早期的报道和许多轶事证据，这些证据描述了在同时使用万古霉素和庆大霉素的新生儿中很少发生肾毒性。
Background The incidence of nephrotoxicity among vancomycin-treated neonates has been reported to range from 2% to 20%. These widely varying estimates have led to confusion and controversy regarding the safety of vancomycin among neonates.Objective Evaluate the incidence of nephrotoxicity among neonates receiving vancomycin concomitantly with gentamicin.Design Retrospective observational cohort study using propensity score matching to provide covariate balance between neonates who did or did not receive vancomycin based on factors known to be related to the development of renal dysfunction.Setting Hospitals (n=22) throughout the Intermountain West, including a quaternary care children's hospital.Patients Neonates 44 postmenstrual weeks (median gestational age: 31 (IQR 28-36) weeks) receiving intravenous gentamicin with or without exposure to vancomycin from January 2006 to December 2012.Main outcome measures Nephrotoxicity based on the modified Acute Kidney Injury Network criteria for acute kidney injury (AKI) or serum creatinine concentration 1.5mg/dL persisting for 48h.Results The final cohort was comprised of 1066 neonates (533 receiving vancomycin and gentamicin vs 533 receiving gentamicin). In a propensity score-matched cohort that was well balanced across 16 covariates, AKI was not associated with vancomycin use (16 neonates receiving vancomycin vs 7 controls experienced AKI; OR 1.5; 95% CI 0.6 to 4.0). However, the presence of a patent ductus arteriosus, concomitant non-steroidal anti-inflammatory drug use, 1 positive blood cultures, low birth weight and higher severity of illness and risk of mortality scores were associated with an increased risk of nephrotoxicity.Conclusions These results corroborate several earlier reports and much anecdotal evidence describing the infrequent occurrence of nephrotoxicity in neonates receiving concomitant vancomycin and gentamicin.