Eichhorn M E, Wolf H, Küchenhoff H, Joka M, Jauch K-W, Hartl W H
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians University Munich, Marchioninistr 15, 81377, Munich, Germany.
Eur J Clin Microbiol Infect Dis. 2007 Jun;26(6):395-402. doi: 10.1007/s10096-007-0305-5.
Randomized controlled trials conducted since 2000 have shown that new antibacterial and antifungal agents may reduce the frequency of kidney injury in selected groups of critically ill patients, yet it is unclear whether these benefits translate to the clinical setting. The aim of the present study was to evaluate longitudinally the successive routine implementation of new antimicrobial agents (caspofungin, voriconazole, linezolid) after February 2002 and the association of these agents with the frequency of mechanical renal replacement therapy in postsurgical critically ill patients at risk of severe kidney failure. A retrospective, observational cohort study was performed using data collected prospectively from 1 March 1993 through 28 February 2005. A cohort of 2,123 consecutive cases who required intensive care therapy for more than 2 days was analysed. A statistically significant decrease in the frequency of renal replacement therapy was observed in the later years of the study. After adjustment for relevant covariates, treatment with new antimicrobial agents after February 2002 was identified as an independent factor linked with a reduced risk of severe kidney failure (odds ratio 0.244; 95% confidence interval 0.136-0.439). Thus, the implementation of new antimicrobial agents with reduced or no nephrotoxicity into routine care of critically ill surgical patients is associated with a reduced need for renal replacement therapy.
2000年以来开展的随机对照试验表明，新型抗菌和抗真菌药物可能会降低特定危重症患者群体的肾损伤发生率，但这些益处能否转化到临床实际情况尚不清楚。本研究的目的是纵向评估2002年2月之后新型抗菌药物（卡泊芬净、伏立康唑、利奈唑胺）的连续常规应用情况，以及这些药物与有严重肾衰竭风险的外科术后危重症患者机械性肾脏替代治疗频率之间的关联。我们进行了一项回顾性观察队列研究，使用了1993年3月1日至2005年2月28日期间前瞻性收集的数据。分析了连续2123例需要重症监护治疗超过2天的病例。在研究后期观察到肾脏替代治疗频率有统计学意义的下降。在对相关协变量进行校正后，2002年2月之后使用新型抗菌药物治疗被确定为与严重肾衰竭风险降低相关的独立因素（比值比0.244；95%置信区间0.136 - 0.439）。因此，将肾毒性降低或无肾毒性的新型抗菌药物应用于危重症外科患者的常规护理中，与肾脏替代治疗需求的减少相关。
