Comparison of the Incidence of Vancomycin-Induced Nephrotoxicity in Hospitalized Patients with and without Concomitant Piperacillin-Tazobactam
Comparison of the Incidence of Vancomycin-Induced Nephrotoxicity in Hospitalized Patients with and without Concomitant Piperacillin-Tazobactam
复制标题
DOI：
10.1002/phar.1442
复制
发表时间：
2014-07-01
期刊：
影响因子：
4.1
通讯作者：
Drew, Richard H.
中科院分区：
文献类型：
--
作者：
Burgess, Lindsey D.;Drew, Richard H.
研究目的：为了确定加入哌拉西林-他唑巴坦是否会增加接受万古霉素治疗的患者肾毒性的发生率，并探索可能增加万古霉素肾毒性风险的潜在混杂因素。设计一项单中心、回顾性队列研究，选择大型、学术、三级护理医院。分析对象为2009年7月1日至2012年7月1日期间在基线肾功能正常的191名成人，任何指征均至少服用万古霉素48小时。在这些患者中，92例在万古霉素治疗的同时接受至少48小时的哌拉西林-他唑巴坦静脉注射(联合组)，在万古霉素开始治疗后48小时内开始注射哌拉西林-他唑巴坦(联合组)；99例接受万古霉素而不使用哌拉西林-他唑巴坦的患者(万古霉素组)。建立了一个多变量模型来比较两组之间肾毒性的主要终点的发生率，肾毒性的定义是血清肌酐浓度至少增加1.5倍。万古霉素组99例患者中有8例(8.1%)发生肾毒性，联合组92例患者中有15例(16.3%)发生肾毒性(单侧卡方检验，p=0.041)。在单变量分析中，只有万古霉素谷浓度大于或等于15微克/毫升(优势比3.67)与发生肾毒性的风险增加相关。在多因素分析中，合并使用哌拉西林-他唑巴坦的患者肾毒性发生率增加，OR值为2.48(单侧卡方检验，p=0.032)。结论我们观察到联合应用哌拉西林-他唑巴坦的患者肾毒性发生率增加。稳态万古霉素谷浓度为15微克/毫升或更高也与发生肾毒性的风险增加有关。这些发现应该在更大规模的随机研究中得到证实。
STUDY OBJECTIVES To determine whether the addition of piperacillin-tazobactam leads to an increased incidence of nephrotoxicity in patients receiving vancomycin and to explore potential confounding factors that may increase the risk of vancomycin-induced nephrotoxicity.DESIGN Single-center, retrospective cohort study.SETTING Large, academic, tertiary-care hospital.PATIENTS One hundred ninety-one adults hospitalized between July 1, 2009, and July 1, 2012, with normal baseline renal function who received a minimum of 48 hours of vancomycin for any indication were included in the analysis. Of these patients, 92 received a minimum of 48 hours of intravenous piperacillin-tazobactam concurrently with vancomycin, with piperacillin-tazobactam being initiated within 48 hours of the initiation of vancomycin (combination group); 99 received vancomycin without piperacillin-tazobactam (vancomycin group).MEASUREMENTS AND MAIN RESULTS A univariate analysis was performed to assess the effect of the following risk factors on the incidence of nephrotoxicity within the first 7 days of vancomycin treatment: concomitant nephrotoxic agents, advanced age, steady-state vancomycin trough concentration of 15 mu g/ml or greater, elevated Charlson Comorbidity Index, and a total daily vancomycin dose of 4 g or greater. A multivariate model was constructed to compare the incidence of the primary end point of nephrotoxicity, defined as a minimum 1.5-fold increase in serum creatinine concentration, between groups. Nephrotoxicity developed in 8 (8.1%) of 99 patients in the vancomycin group and in 15 (16.3%) of 92 patients in the combination group (1-sided chi(2) test, p=0.041). In the univariate analysis, only vancomycin trough concentration of 15 mu g/ml or greater (odds ratio 3.67) was associated with an increased risk of developing nephrotoxicity. In the multivariate analysis, patients with piperacillin-tazobactam added to vancomycin exhibited an increased incidence of nephrotoxicity, with an odds ratio of 2.48 (1-sided chi(2) test, p=0.032).CONCLUSION We observed an increased incidence of nephrotoxicity in vancomycin-treated patients who received concomitant piperacillin-tazobactam. A steady-state vancomycin trough concentration of 15 mu g/ml or greater was also associated with an increased risk of the development of nephrotoxicity. These findings should be confirmed in larger, randomized studies.