Department of Pharmacy Practice, ETSU Bill Gatton College of Pharmacy, Johnson City, TN, USA.
ETSU Bill Gatton College of Pharmacy, Johnson City, TN, USA.
J Clin Pharm Ther. 2020 Dec;45(6):1253-1263. doi: 10.1111/jcpt.13249. Epub 2020 Aug 18.
Acute kidney injury is a devastating consequence observed with antibiotic therapy. The objective of this review was to summarize available data regarding the rates of acute kidney injury with vancomycin plus piperacillin/tazobactam compared to other beta-lactam combinations.
A PubMed search from 2011 to May 2020 was conducted using the following search terms: vancomycin AND piperacillin/tazobactam AND acute kidney injury. Additional references were identified from a review of citations. Articles evaluating exclusively paediatric patients and articles evaluating vancomycin monotherapy as the comparator group were excluded. Case reports and case series were also excluded.
There were 18 studies included. Ten studies adjusted for potential confounders of acute kidney injury. Fourteen retrospective studies, one prospective study and three meta-analyses found the combination of vancomycin/piperacillin/tazobactam to be associated with a higher rate of acute kidney injury than the comparator group(s).
Although there are data to support that the combination of vancomycin plus piperacillin-tazobactam increases the risk of acute kidney, much of the data come from small retrospective studies with variable adjustment for confounders. Furthermore, study heterogeneity on inclusion criteria and evaluation of long-term outcomes should be cautiously interpreted. Finally, additional data suggest that the risk of acute kidney injury seems to be minimized with shorter courses of therapy. Without prospective studies available, antimicrobial stewardship efforts should continue to target reducing broad-spectrum regimens, often limiting the need for long-term vancomycin/piperacillin/tazobactam combination.
抗生素治疗会导致急性肾损伤，这是一种破坏性的后果。本综述的目的是总结关于万古霉素加哌拉西林/他唑巴坦与其他β-内酰胺类联合用药相比发生急性肾损伤的发生率的现有数据。
使用以下搜索词在 2011 年至 2020 年 5 月期间进行了 PubMed 搜索：万古霉素和哌拉西林/他唑巴坦和急性肾损伤。从参考文献的审查中确定了其他参考文献。仅评估儿科患者的文章和将万古霉素单药治疗作为对照药物组的文章被排除在外。病例报告和病例系列也被排除在外。
共纳入 18 项研究。有 10 项研究调整了急性肾损伤的潜在混杂因素。14 项回顾性研究、1 项前瞻性研究和 3 项荟萃分析发现，与对照组相比，万古霉素/哌拉西林/他唑巴坦联合用药与更高的急性肾损伤发生率相关。
尽管有数据支持万古霉素加哌拉西林-他唑巴坦联合用药会增加急性肾损伤的风险，但大部分数据来自小型回顾性研究，对混杂因素的调整存在差异。此外，关于纳入标准和长期结局评估的研究异质性应谨慎解释。最后，其他数据表明，急性肾损伤的风险似乎可以通过缩短疗程来最小化。由于没有前瞻性研究，抗菌药物管理工作应继续针对减少广谱方案，通常限制长期万古霉素/哌拉西林/他唑巴坦联合用药的需求。
