Billups Kelsey B, Reed Erica E, Phillips Gary S, Stevenson Kurt B, Steinberg Steven M, Murphy Claire V
Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA.
Int J Crit Illn Inj Sci. 2018 Jan-Mar;8(1):22-27. doi: 10.4103/IJCIIS.IJCIIS_46_17.
Vancomycin and linezolid are standard treatment options for nosocomial methicillin-resistant (MRSA) pneumonia. While acute kidney injury (AKI) is commonly attributed to vancomycin, existing data has not definitely confirmed vancomycin as an independent risk factor for AKI.
This study aimed to quantify the incidence of AKI in Surgical Intensive Care Unit (ICU) patients receiving empiric vancomycin or linezolid for nosocomial pneumonia and to identify risk factors for AKI with a focus on MRSA antibiotic therapy.
A retrospective cohort analysis of surgical ICU patients who received at least 48 h of vancomycin or linezolid for pneumonia was performed. Patients who received vancomycin were compared to those who received linezolid with a primary endpoint of AKI as defined by the risk/injury/failure/loss/end-stage renal disease (RIFLE) criteria. A modified RIFLE criteria assessing only changes in serum creatinine was also used.
One hundred one patients were evaluated (63 vancomycin and 38 linezolid). AKI occurred in 51 (81.0%) and 32 (84.2%) patients in the vancomycin and linezolid groups ( = 0.79), respectively. Using the modified RIFLE criteria, AKI occurred in 19 (30.2%) and 14 (36.8%) patients in the vancomycin and linezolid groups ( = 0.448). After adjustment for age, diabetes mellitus, Charlson comorbidity index, and concomitant nephrotoxins, there was no difference in risk of AKI between groups ( = 0.773).
Patients who received empiric vancomycin or linezolid for nosocomial pneumonia experienced high, but similar rates of AKI. The results suggest MRSA antibacterial therapy in this setting may not be independently indicative of AKI risk, rather the risk is likely multifactorial.
万古霉素和利奈唑胺是医院获得性耐甲氧西林金黄色葡萄球菌（MRSA）肺炎的标准治疗选择。虽然急性肾损伤（AKI）通常归因于万古霉素，但现有数据尚未明确证实万古霉素是AKI的独立危险因素。
本研究旨在量化接受经验性万古霉素或利奈唑胺治疗医院获得性肺炎的外科重症监护病房（ICU）患者中AKI的发生率，并确定AKI的危险因素，重点关注MRSA抗生素治疗。
对接受至少48小时万古霉素或利奈唑胺治疗肺炎的外科ICU患者进行回顾性队列分析。将接受万古霉素治疗的患者与接受利奈唑胺治疗的患者进行比较，以AKI为主要终点，AKI由风险/损伤/衰竭/丧失/终末期肾病（RIFLE）标准定义。还使用了仅评估血清肌酐变化的改良RIFLE标准。
共评估了101例患者（63例接受万古霉素治疗，38例接受利奈唑胺治疗）。万古霉素组和利奈唑胺组分别有51例（81.0%）和32例（84.2%）患者发生AKI（P = 0.79）。使用改良RIFLE标准，万古霉素组和利奈唑胺组分别有19例（30.2%）和14例（36.8%）患者发生AKI（P = 0.448）。在调整年龄、糖尿病、Charlson合并症指数和合并使用肾毒素后，两组间AKI风险无差异（P = 0.773）。
接受经验性万古霉素或利奈唑胺治疗医院获得性肺炎的患者AKI发生率较高，但相似。结果表明，在这种情况下，MRSA抗菌治疗可能并非独立提示AKI风险，而是该风险可能是多因素的。
