Department of Pharmacy, Wan Fang Hospital College of Pharmacy School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.
Nephrology (Carlton). 2011 Nov;16(8):697-703. doi: 10.1111/j.1440-1797.2011.01488.x.
Vancomycin and teicoplanin are the two most used glycopeptides for the treatment of methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is suspected to have more nephrotoxicity but this has not been clearly established. The aim of this study was to assess its nephrotoxicity by a consensus definition of acute kidney injury (AKI): the risk (R), injury (I), failure (F), loss and end-stage renal disease (RIFLE) classification.
Patients with MRSA bacteraemia who were prescribed either vancomycin or teicoplanin between 2003 and 2008 were classified. Patients who developed AKI were classified by RIFLE criteria. Variables such as comorbidities, laboratory data and medical cost information were also obtained from the database. Outcomes determined were: (i) the rate of nephrotoxicity and mortality; and (ii) the association of nephrotoxicity with the length of hospital stay and costs.
The study included 190 patients (vancomycin 33, teicoplanin 157). Fifteen patients on vancomycin and 27 patients on teicoplanin developed AKI (P = 0.0004). In the vancomycin group, four, eight and three patients were classified to RIFLE criteria R, I and F, respectively. In the teicoplanin group, 17, nine and one patient were classified to RIFLE criteria R, I and F, respectively. Kaplan-Meier analysis showed significant difference in time to nephrotoxicity for the vancomycin group compared to the teicoplanin group. No significant differences were found between the groups in terms of total mortality, length of hospital stay and costs.
The study data suggest that vancomycin is associated with a higher likelihood of nephrotoxicity using the RIFLE classification.
万古霉素和替考拉宁是治疗耐甲氧西林金黄色葡萄球菌（MRSA）的两种最常用糖肽类抗生素。万古霉素被怀疑具有更高的肾毒性，但这一点尚未得到明确证实。本研究旨在通过急性肾损伤（AKI）的共识定义来评估其肾毒性：风险（R）、损伤（I）、衰竭（F）、损失和终末期肾病（RIFLE）分类。
对 2003 年至 2008 年间接受万古霉素或替考拉宁治疗的 MRSA 菌血症患者进行分类。根据 RIFLE 标准对发生 AKI 的患者进行分类。还从数据库中获取了合并症、实验室数据和医疗费用信息等变量。确定的结果为：（i）肾毒性和死亡率的发生率；以及（ii）肾毒性与住院时间和费用的关系。
研究共纳入 190 例患者（万古霉素 33 例，替考拉宁 157 例）。万古霉素组 15 例和替考拉宁组 27 例患者发生 AKI（P=0.0004）。万古霉素组中，4 例、8 例和 3 例患者分别被归类为 RIFLE 标准的 R、I 和 F 期。替考拉宁组中，17 例、9 例和 1 例患者分别被归类为 RIFLE 标准的 R、I 和 F 期。Kaplan-Meier 分析显示，万古霉素组发生肾毒性的时间明显长于替考拉宁组。两组在总死亡率、住院时间和费用方面无显著差异。
研究数据表明，万古霉素组使用 RIFLE 分类时肾毒性的可能性更高。
