Papadimitriou-Olivgeris Matthaios, Assimakopoulos Stelios F, Kolonitsiou Fevronia, Solomou Anastasia, Vamvakopoulou Sophia, Spyropoulou Aikaterini, Karamouzos Vasileios, Anastassiou Evangelos D, Papachristou Evangelos, Spiliopoulou Iris, Christofidou Myrto, Fligou Fotini, Marangos Markos
Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Patras, Rion-Patras, Greece; Department of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland.
Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Patras, Rion-Patras, Greece.
Infez Med. 2019 Dec 1;27(4):380-392.
The objectives of the present study were to identify risk factors for development of acute kidney injury (AKI) during the treatment of bacteraemia due to carbapenem non-susceptible Gram-negative bacteria (CnS-GNB) and its role on mortality. Data of all patients with bacteraemia by CnS-GNB in the intensive care unit of a tertiary hospital from 2012 to 2016 were included. AKI was defined by AKIN criteria. Secondary outcomes were AKI development in patients treated with colistin and predictors of 14-day mortality. Among 285 episodes of bacteraemia due to CnS-GNB, 84 (29.5%) developed AKI. Multivariate analysis revealed that obesity, septic shock, maximum noradrenaline dose and eGFR<60 mL/min/1.73m² upon bacteraemia onset were independently associated with development of AKI. Out of 228 patients receiving colistin, 64 (28.1%) developed AKI. Multivariate analysis found the same factors as before in addition to voriconazole administration. Fourteen-day mortality was 34.2% and was independently associated with bacteraemia by Pseudomonas aeruginosa, AKI during bacteraemia treatment, maximum noradrenaline dose, SAPS II and SOFA scores upon bacteraemia onset, whereas appropriate combination therapy and catheter-related bacteraemia were independently associated with better survival. AKI was a frequent complication of bacteraemia by CnS-GNB and was associated with septic shock and baseline renal function impairment. Mortality was higher among patients that developed AKI due to bacteraemia. Colistin should be considered a safe therapeutic option for treating such infections.
本研究的目的是确定碳青霉烯类不敏感革兰氏阴性菌（CnS-GNB）所致菌血症治疗期间急性肾损伤（AKI）发生的危险因素及其对死亡率的影响。纳入了2012年至2016年一家三级医院重症监护病房中所有由CnS-GNB引起菌血症的患者数据。AKI根据AKIN标准定义。次要结局是接受黏菌素治疗患者的AKI发生情况以及14天死亡率的预测因素。在285例由CnS-GNB引起的菌血症发作中，84例（29.5%）发生了AKI。多变量分析显示，肥胖、感染性休克、最大去甲肾上腺素剂量以及菌血症发作时估算肾小球滤过率（eGFR）<60 mL/min/1.73m²与AKI的发生独立相关。在228例接受黏菌素治疗的患者中，64例（28.1%）发生了AKI。多变量分析发现，除伏立康唑用药外，与之前的因素相同。14天死亡率为34.2%，并与铜绿假单胞菌引起的菌血症以及菌血症治疗期间的AKI、最大去甲肾上腺素剂量、菌血症发作时的序贯器官衰竭评估（SOFA）评分和简化急性生理学评分（SAPS II）独立相关，而适当的联合治疗和导管相关菌血症与更好的生存率独立相关。AKI是CnS-GNB所致菌血症的常见并发症，与感染性休克和基线肾功能损害有关。因菌血症发生AKI的患者死亡率更高。黏菌素应被视为治疗此类感染的安全治疗选择。
