Division of Infectious Diseases, Cleveland Clinic Akron General.
Department of Medicine, Northeast Ohio Medical University, Rootstown.
Clin Infect Dis. 2017 Nov 29;65(12):2137-2143. doi: 10.1093/cid/cix675.
Early administration of appropriate empiric antibiotics is essential for achieving the best possible outcomes in sepsis. Yet the choice of antibiotic therapy has become more challenging due to recent reports of nephrotoxicity with the combination of vancomycin and piperacillin/tazobactam, the "workhorse" regimen at many institutions. In this article we assess the evidence for nephrotoxicity and its possible mechanisms, provide recommendations for risk mitigation, address the advantages and disadvantages of alternative antibiotic choices, and suggest areas for future research.
早期给予适当的经验性抗生素治疗对于脓毒症获得最佳治疗效果至关重要。然而，由于最近有报道称万古霉素与哌拉西林/他唑巴坦联合使用具有肾毒性，而该联合用药方案在许多医疗机构是“主力”治疗方案，使得抗生素治疗方案的选择变得更加具有挑战性。本文评估了其肾毒性的证据及其可能的机制，提出了降低风险的建议，讨论了替代抗生素选择的优缺点，并提出了未来研究的方向。
