Use of aminoglycosides for peritoneal dialysis-associated peritonitis does not affect residual renal function
Use of aminoglycosides for peritoneal dialysis-associated peritonitis does not affect residual renal function
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DOI：
10.1093/ndt/gfr274
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发表时间：
2012-01-01
影响因子：
6.1
通讯作者：
Johnson, David W.
中科院分区：
文献类型：
--
作者：
Badve, Sunil V.;Hawley, Carmel M.;Johnson, David W.
背景。氨基糖苷类药物在治疗腹膜透析 (PD) 相关腹膜炎方面具有多种潜在优势，包括成本低、对革兰氏阴性菌（包括铜绿假单胞菌）具有活性、对某些革兰氏阳性菌（如葡萄球菌）具有协同杀菌活性以及相对较低的促进抗菌药物耐药性的倾向。然而，有限的相互矛盾的证据表明氨基糖苷类药物可能会加速 PD 患者残余肾功能 (RRF) 的丧失。本研究的目的是研究氨基糖苷类药物的使用对 RRF 下降斜率的影响。方法。该研究纳入了 2715 名 2003 年 10 月至 2007 年 12 月期间接受 PD 的澳大利亚患者，其中至少有两次肾肌酐清除率测量结果。根据 RRF 下降斜率的三分位数（快速、中等和慢速）对患者进行分类。主要结果是接受氨基糖苷类治疗腹膜炎腹膜炎的患者与未接受氨基糖苷类治疗的患者的 RRF 随时间的斜率。结果。共有 1412 名患者 (52%) 经历过至少一次腹膜透析腹膜炎发作。 1075 名患者使用氨基糖苷类作为初始经验性抗生素。接受和未接受至少一个疗程氨基糖苷类药物治疗的患者的 RRF 下降斜率相似（中位[四分位距] -0.26 [-1.17 至 0.04] mL/min/1.73 m(2)/月 vs -0.22 [-1.11 至 0.01] mL/min/1.73 m(2)/月，P = 0.9）。在接受重复疗程的氨基糖苷类药物的患者中，RRF 下降的斜率也相似。结论。氨基糖苷类腹膜炎经验性治疗与腹膜透析患者的 RRF 不良反应无关。
Background. Aminoglycosides offer several potential benefits in their treatment of peritoneal dialysis (PD)-associated peritonitis, including low cost, activity against Gram-negative organisms (including Pseudomonas aeruginosa), synergistic bactericidal activity against some Gram-positive organisms (such as Staphylococci) and relatively low propensity to promote antimicrobial resistance. However, there is limited conflicting evidence that aminoglycosides may accelerate loss of residual renal function (RRF) in PD patients. The aim of this study was to study the effect of aminoglycoside use on slope of decline in RRF.Methods. The study included 2715 Australian patients receiving PD between October 2003 and December 2007 in whom at least two measurements of renal creatinine clearance were available. Patients were divided according to tertiles of slope of RRF decline (rapid, intermediate and slow). The primary outcome was the slope of RRF over time in patients who received aminoglycosides for PD peritonitis versus those who did not.Results. A total of 1412 patients (52%) experienced at least one episode of PD peritonitis. An aminoglycoside was used as the initial empiric antibiotic in 1075 patients. The slopes of RRF decline were similar in patients treated and not treated with at least one course of aminoglycoside (median [interquartile range] -0.26 [-1.17 to 0.04] mL/min/1.73 m(2)/month versus -0.22 [-1.11 to 0.01] mL/min/1.73 m(2)/month, P = 0.9). The slopes of RRF decline were also similar in patients receiving repeated courses of aminoglycoside.Conclusions. Empiric treatment with aminoglycoside for peritonitis was not associated with an adverse effect on RRF in PD patients.