万古霉素相关性肾毒性：肥胖因素
Vancomycin-Associated Nephrotoxicity: The Obesity Factor.
作者信息
Davies Stephen W, Efird Jimmy T, Guidry Christopher A, Dietch Zachary C, Willis Rhett N, Shah Puja M, Hennessy Sara A, Sawyer Robert G
机构信息
1 Department of General Surgery, University of Virginia School of Medicine , Charlottesville, Virginia.
2 Biostatistics Unit, Center for Health Disparities, Brody School of Medicine, East Carolina University , Greenville, North Carolina.
出版信息
Surg Infect (Larchmt). 2015 Dec;16(6):684-93. doi: 10.1089/sur.2014.198. Epub 2015 Sep 1.
BACKGROUND
Current recommendations suggest that vancomycin dosing utilize actual rather than ideal body weight in obese patients. Thus, obese patients may be at greater risk for nephrotoxicity. The purpose of this study was to compare the incidence of nephrotoxicity in vancomycin-treated obese and lean patients at our institution, where unadjusted, actual body weight-based dosing (capped at 2 g per dose twice daily) is used. We expected obese patients to experience a greater incidence of nephrotoxicity than lean patients.
METHODS
This study examined a retrospective cohort of patients treated with vancomycin for gram-positive or mixed infections in our facility from 2005-2009 who were not receiving hemodialysis at the time of admission. Patients were stratified by body mass index (BMI; obese ≥30 kg/m(2) vs. lean <30 kg/m(2)). Relative risk (RR), 95% confidence intervals (CIs), and p values were computed using a generalized estimating equation to accommodate a correlated data structure corresponding to multiple episodes of infection per individual. Multivariable analysis was performed.
RESULTS
A total of 530 patients (207 obese; 323 lean) with 1,007 episodes of infection were treated with vancomycin. Patient demographics, co-morbidities, sites of infection, and infecting organisms were similar in the two groups. Female gender (p=0.042), diabetes mellitus (DM) (p=0.018), and hypertension (HTN) (p=0.0009) were more often associated with obesity, whereas allografts (p=0.022) and peripheral vascular disease (p=0.036) were more often present in lean patients. The Acute Physiology and Chronic Health Evaluation II score >21 was the only variable associated with nephrotoxicity (p=0.039). After adjusting for statistically significant variables, obesity was found not to be associated with a greater risk of nephrotoxicity (RR=0.98; 95% CI=0.93-1.04; p=0.59).
CONCLUSION
No difference in nephrotoxicity was observed between lean and obese patients treated with vancomycin at our institution.
背景
当前建议指出，肥胖患者使用万古霉素时应依据实际体重而非理想体重来给药。因此，肥胖患者发生肾毒性的风险可能更高。本研究的目的是比较在我院接受万古霉素治疗的肥胖患者和非肥胖患者中肾毒性的发生率，我院采用的是基于未调整的实际体重给药（每日两次，每次剂量上限为2克）。我们预期肥胖患者肾毒性的发生率高于非肥胖患者。
方法
本研究对2005年至2009年期间在我院因革兰氏阳性或混合感染接受万古霉素治疗且入院时未接受血液透析的患者进行回顾性队列研究。患者按体重指数（BMI；肥胖患者BMI≥30kg/m²，非肥胖患者BMI<30kg/m²）进行分层。使用广义估计方程计算相对风险（RR）、95%置信区间（CI）和p值，以适应与个体多次感染发作相对应的相关数据结构。进行多变量分析。
结果
共有530例患者（207例肥胖患者；323例非肥胖患者）发生1007次感染发作并接受了万古霉素治疗。两组患者的人口统计学特征、合并症、感染部位和感染病原体相似。女性（p=0.042）、糖尿病（DM）（p=0.018）和高血压（HTN）（p=0.0009）更常与肥胖相关，而异体移植（p=0.022）和外周血管疾病（p=0.036）在非肥胖患者中更常见。急性生理与慢性健康状况评分II>21是与肾毒性相关的唯一变量（p=0.039）。在对具有统计学意义的变量进行调整后，发现肥胖与肾毒性风险增加无关（RR=0.98；95%CI=0.93-1.04；p=0.59）。
结论
在我院接受万古霉素治疗的肥胖患者和非肥胖患者中，未观察到肾毒性方面的差异。
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