Department of Clinical Pharmacy, OLVG, Amsterdam, The Netherlands.
Department of Intensive Care Medicine, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands.
J Antimicrob Chemother. 2021 Dec 24;77(1):246-252. doi: 10.1093/jac/dkab372.
Continuous infusion of conventional amphotericin B (CCAB) is used in ICUs for pre-emptive treatment of invasive fungal infections. Amphotericin B has previously been associated with nephrotoxicity.
To investigate if CCAB with therapeutic drug monitoring (TDM) results in renal impairment over time in critically ill patients with abdominal sepsis.
The study was conducted at mixed medical-surgical ICUs of two large teaching hospitals in the Netherlands. Consecutive patients who were treated on the ICUs between 2006 and 2019 for abdominal sepsis, with or without CCAB, were included. CCAB dosing was guided by TDM. Serum creatinine concentrations and renal failure scores of patients with CCAB treatment were compared with those without CCAB treatment. Excluded were: (i) patients treated with CCAB for less than 72 h; and (ii) patients with renal replacement therapy.
A total of 319 patients were included (185 treated with CCAB and 134 controls). A multiple linear regression model showed that the serum creatinine concentration was independent of CCAB treatment (β = -0.023; 95% CI = -12.2 to 7.2; P = 0.615). Propensity score matching resulted in 134 pairs of CCAB-treated and non-treated patients. Again, the analysis of these pairs showed that the cumulative CCAB dose was not associated with serum creatinine concentration during intensive care treatment (β = 0.299; 95% CI = -0.38 to 0.98; P = 0.388).
CCAB with TDM did not result in renal impairment over time in critically ill patients with abdominal sepsis.
连续输注常规两性霉素 B（CCAB）被用于 ICU 中进行侵袭性真菌感染的预防性治疗。两性霉素 B 以前与肾毒性有关。
研究在患有腹部脓毒症的危重症患者中，使用治疗药物监测（TDM）的 CCAB 是否会随时间推移导致肾功能损害。
该研究在荷兰两家大型教学医院的混合内科-外科 ICU 进行。纳入 2006 年至 2019 年期间在 ICU 接受治疗的腹部脓毒症患者，无论是否接受 CCAB 治疗，均进行连续性研究。CCAB 的剂量由 TDM 指导。比较接受 CCAB 治疗和未接受 CCAB 治疗的患者的血清肌酐浓度和肾功能衰竭评分。排除标准为：（i）接受 CCAB 治疗少于 72 小时的患者；（ii）接受肾脏替代治疗的患者。
共纳入 319 例患者（185 例接受 CCAB 治疗，134 例为对照组）。多元线性回归模型显示，血清肌酐浓度与 CCAB 治疗无关（β=-0.023；95%CI=-12.2 至 7.2；P=0.615）。采用倾向评分匹配得到 134 对接受 CCAB 治疗和未接受治疗的患者。同样，对这些配对患者的分析表明，在 ICU 治疗期间，CCAB 的累积剂量与血清肌酐浓度无关（β=0.299；95%CI=-0.38 至 0.98；P=0.388）。
在患有腹部脓毒症的危重症患者中，使用 TDM 的 CCAB 不会随时间推移导致肾功能损害。
