社区处方抗生素后急性肾损伤的风险：自身对照病例系列研究。

Risk of acute kidney injury following community prescription of antibiotics: self-controlled case series.

机构信息

Renal Unit, Ninewells Hospital, NHS Tayside, Dundee, UK.

Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK.

出版信息

Nephrol Dial Transplant. 2019 Nov 1;34(11):1910-1916. doi: 10.1093/ndt/gfy187.

DOI:10.1093/ndt/gfy187

PMID:29961876

Abstract

BACKGROUND

Development of acute kidney injury (AKI) following the use of antibiotics such as sulphonamides, trimethoprim and aminoglycosides is a frequently described phenomenon. More recently, an association between fluoroquinolone use and AKI has been suggested. The aim of this study was to evaluate the risk of AKI as an unintended consequence of commonly prescribed antibiotics in a large community cohort using a method that fully adjusts for underlying patient characteristics, including potential unmeasured confounders.

METHODS

A self-controlled case study was conducted and included all individuals aged 18 years and over in the Tayside region of Scotland who had a serum creatinine measured between 1 January 2004 and 31 December 2012. AKI episodes were defined using the Kidney Disease: Improving Global Outcomes definition. Data on oral community-prescribed antibiotics (penicillins, cephalosporins, fluoroquinolones, sulphonamides and trimethoprim, macrolides and nitrofurantoin) were collected for all individuals. Incidence rate ratios (IRRs) for AKI associated with antibiotic exposure versus time periods without antibiotic exposure were calculated.

RESULTS

Combined use of sulphonamides, trimethoprim and nitrofurantoin rose by 47% and incidence of community-acquired AKI rose by 16% between 2008 and 2012. During the study period 12 777 individuals developed 14 900 episodes of AKI in the community, of which 68% was AKI Stage 1, 16% Stage 2 and 16% Stage 3. The IRR of AKI during any antibiotic use was 1.16 [95% confidence interval (CI) 1.10-1.23], and this was highest during sulphonamides or trimethoprim use; IRR 3.07 (95% CI 2.81-3.35). Fluoroquinolone and nitrofurantoin use was not associated with a significantly increased rate of AKI; IRR 1.13 (95% CI 0.94-1.35) and 1.16 (95% CI 0.91-1.50), respectively.

CONCLUSIONS

Incidence of AKI rose by 16% between 2008 and 2012. In the same period the use of sulphonamides, trimethoprim and nitrofurantoin increased by 47%. A significant increased risk of AKI was seen with the use of sulphonamides and trimethoprim, but not with fluoroquinolones or nitrofurantoin.

摘要

背景

使用磺胺类药物、甲氧苄啶和氨基糖苷类抗生素等抗生素后发生急性肾损伤（AKI）是一种经常描述的现象。最近，有人提出氟喹诺酮类药物的使用与 AKI 之间存在关联。本研究旨在使用一种充分调整患者基础特征（包括潜在的未测量混杂因素）的方法，在一个大型社区队列中评估常用抗生素作为意外后果导致 AKI 的风险。

方法

进行了一项自我对照病例研究，包括苏格兰泰赛德地区所有年龄在 18 岁及以上、2004 年 1 月 1 日至 2012 年 12 月 31 日期间检测血清肌酐的个体。使用肾脏疾病：改善全球结局定义来定义 AKI 发作。收集了所有个体的口服社区处方抗生素（青霉素、头孢菌素、氟喹诺酮类、磺胺类和甲氧苄啶、大环内酯类和呋喃妥因）的数据。计算了抗生素暴露与无抗生素暴露期间 AKI 相关的发病率比值比（IRR）。

结果

2008 年至 2012 年间，磺胺类、甲氧苄啶和呋喃妥因联合使用增加了 47%，社区获得性 AKI 的发病率增加了 16%。在研究期间，12777 名个体在社区中发生了 14900 例 AKI 发作，其中 68%为 AKI 1 期，16%为 AKI 2 期，16%为 AKI 3 期。任何抗生素使用期间 AKI 的 IRR 为 1.16（95%置信区间 1.10-1.23），磺胺类或甲氧苄啶使用期间最高；IRR 为 3.07（95%置信区间 2.81-3.35）。氟喹诺酮类和呋喃妥因的使用与 AKI 发生率的显著增加无关；IRR 分别为 1.13（95%置信区间 0.94-1.35）和 1.16（95%置信区间 0.91-1.50）。