Department of Pharmacy, 24144Scripps Mercy Hospital, San Diego, CA, USA.
Department of Pharmacy Practice, 15474Midwestern University College of Pharmacy-Glendale, Glendale, AZ, USA.
J Intensive Care Med. 2020 Dec;35(12):1434-1438. doi: 10.1177/0885066619828290. Epub 2019 Feb 10.
The objective of this study was to compare the incidence of acute kidney injury (AKI) among critically ill patients receiving combination therapy with vancomycin plus piperacillin-tazobactam (VPT) against patients receiving vancomycin plus cefepime (VC).
A retrospective cohort study of adult patients admitted to an intensive care unit between September 2012 and December 2016 was conducted. Patients were included if they received combination therapy with VPT or VC for ≥48 hours. Patients were excluded if creatinine clearance was <60 mL/min or received renal replacement therapy prior to the initiation of therapy. The primary end point was AKI, as defined by the Acute Kidney Injury Network classification, during or within 48 hours of completion of therapy. The incidence of AKI was compared between groups and multivariate analysis was performed to control for relevant confounders.
A total of 394 patients received either VPT (n = 258) or VC (n = 136). There were no differences in baseline serum creatinine (0.8 [0.3]mg/dL vs 0.7 [0.3] mg/dL, = 0.207), use of vasopressors (44% vs 38%, = 0.255), mechanical ventilation (45% vs 40%, = 0.350), or initial vancomycin trough (11.2 [5] mg/L vs 11 [4.8] mg/L, = 0.668) between VPT and VC groups, respectively. The incidence of AKI was 28.7% for VPT patients versus 21.3% for VC patients ( = 0.114). Multivariate analysis revealed vancomycin trough >20 mg/L (odds ratio, OR [95% confidence interval, CI] = 2.69 [1.62-4.47]), baseline SCr (OR [95% CI] = 3.34 [1.43-7.80]), vasopressors (OR [95% CI] = 1.77 [1.04-3.04]), and duration of combination therapy (OR [95% CI] = 1.009 [1.003-1.015]) as independent risk factors for AKI.
The risk of AKI was similar between VPT and VC groups in critically ill patients. Risk factors for AKI were related to baseline renal function, duration of combination therapy, supratherapeutic vancomycin troughs, and severity of illness.
本研究旨在比较接受万古霉素联合哌拉西林他唑巴坦（VPT）与万古霉素联合头孢吡肟（VC）治疗的危重症患者中急性肾损伤（AKI）的发生率。
这是一项对 2012 年 9 月至 2016 年 12 月间入住重症监护病房的成年患者进行的回顾性队列研究。如果患者接受 VPT 或 VC 治疗 ≥48 小时，则将其纳入研究。如果患者肌酐清除率 <60 mL/min 或在开始治疗前接受肾脏替代治疗，则将其排除在外。主要终点是治疗期间或治疗结束后 48 小时内 AKI 的发生，定义为急性肾损伤网络分类。对各组之间 AKI 的发生率进行比较，并进行多变量分析以控制相关混杂因素。
共 394 例患者接受 VPT（n = 258）或 VC（n = 136）治疗。两组间基线血清肌酐（0.8 [0.3]mg/dL vs 0.7 [0.3]mg/dL， = 0.207）、使用血管加压药（44% vs 38%， = 0.255）、机械通气（45% vs 40%， = 0.350）或初始万古霉素谷浓度（11.2 [5]mg/L vs 11 [4.8]mg/L， = 0.668）均无差异。VPT 组 AKI 的发生率为 28.7%，VC 组为 21.3%（ = 0.114）。多变量分析显示，万古霉素谷浓度>20mg/L（比值比[95%置信区间] = 2.69 [1.62-4.47]）、基线 SCr（比值比[95%置信区间] = 3.34 [1.43-7.80]）、血管加压药（比值比[95%置信区间] = 1.77 [1.04-3.04]）和联合治疗时间（比值比[95%置信区间] = 1.009 [1.003-1.015]）是 AKI 的独立危险因素。
在危重症患者中，VPT 和 VC 组 AKI 的风险相似。AKI 的危险因素与基线肾功能、联合治疗时间、超治疗谷浓度万古霉素和疾病严重程度有关。
