University of Kentucky HealthCare, Lexington, Kentucky, USA.
University of Kentucky, College of Pharmacy, Lexington, Kentucky, USA.
Antimicrob Agents Chemother. 2017 Sep 22;61(10). doi: 10.1128/AAC.00871-17. Print 2017 Oct.
Limited literature is available assessing nephrotoxicity with prolonged β-lactam infusions. This study compared the incidence of acute kidney injury (AKI) associated with a prolonged β-lactam infusion or an intermittent infusion. This was a retrospective, matched-cohort study at an academic medical center from July 2006 to September 2015. Adult patients who received piperacillin-tazobactam (TZP), cefepime (FEP), or meropenem (MEM) for at least 48 h were evaluated. Patients were excluded for preexisting renal dysfunction or pregnancy. The primary outcome was difference in incidence of AKI evaluated using the RIFLE (risk, injury, failure, loss, and end-stage) criteria. Patients in the intermittent group were matched 3:1 to patients in the prolonged-infusion group based on the following: β-lactam agent, age, gender, Charlson comorbidity index, baseline creatinine clearance, hypotension, receipt of vancomycin, and treatment in an intensive care unit. A total of 2,390 patients were included in the matched analysis, with 1,700 receiving intermittent infusions and 690 receiving prolonged infusion. The incidence of AKI was similar in the prolonged-infusion group to that in the intermittent-infusion group (21.6% versus 18.6%; = 0.1). After multivariate regression, prolonged infusion was not associated with increased odds of AKI (odds ratio [OR], 1.07; 95% confidence interval [95% CI], 0.83 to 1.39). Independent predictors of AKI included TZP therapy, concomitant nephrotoxins, hypotension, and heart failure. Although AKIs were numerically more common in patients receiving prolonged β-lactam infusions than those receiving intermittent infusions, prolonged infusion was not an independent risk factor for AKI.
关于延长β-内酰胺输注时间与肾毒性的相关文献有限。本研究比较了与延长β-内酰胺输注或间歇性输注相关的急性肾损伤（AKI）的发生率。这是 2006 年 7 月至 2015 年 9 月在一家学术医疗中心进行的回顾性匹配队列研究。评估了至少接受过哌拉西林他唑巴坦（TZP）、头孢吡肟（FEP）或美罗培南（MEM）治疗 48 小时以上的成年患者。对于存在肾功能不全或妊娠的患者，则排除在外。主要结局是使用 RIFLE（风险、损伤、衰竭、丧失和终末期）标准评估 AKI 的发生率差异。根据以下因素，将间歇性输注组的患者与延长输注组的患者进行 3:1 匹配：β-内酰胺药物、年龄、性别、Charlson 合并症指数、基线肌酐清除率、低血压、万古霉素的使用以及在重症监护病房接受治疗。共有 2390 名患者纳入了匹配分析，其中 1700 名患者接受间歇性输注，690 名患者接受延长输注。延长输注组 AKI 的发生率与间歇性输注组相似（21.6%比 18.6%；=0.1）。多变量回归后，延长输注与 AKI 的发生几率增加无关（比值比 [OR]，1.07；95%置信区间 [95%CI]，0.83 至 1.39）。AKI 的独立预测因素包括 TZP 治疗、同时使用肾毒性药物、低血压和心力衰竭。尽管接受延长β-内酰胺输注的患者 AKI 发生率略高于接受间歇性输注的患者，但延长输注不是 AKI 的独立危险因素。
