Demotier Sophie, Limelette Anne, Charmillon Alexandre, Baux Elisabeth, Parent Xavier, Mestrallet Stéphanie, Pavel Simona, Servettaz Amélie, Dramé Moustapha, Muggeo Anaelle, Wynckel Alain, Gozalo Claire, Taam Malak Abou, Fillion Aurélie, Jaussaud Roland, Trenque Thierry, Piroth Lionel, Bani-Sadr Firouze, Hentzien Maxime
Service de Médecine Interne- Maladies infectieuses, Immunologie Clinique. Centre Hospitalier Universitaire Robert Debré, Reims, France.
Laboratoire de Bactériologie, Centre Hospitalier Universitaire Robert Debré, Reims, France.
EClinicalMedicine. 2022 Mar 12;45:101340. doi: 10.1016/j.eclinm.2022.101340. eCollection 2022 Mar.
Amoxicillin crystalluria (AC), potentially responsible for acute kidney injury (AKI), is reported more and more frequently in patients treated with high doses of intravenous amoxicillin (HDIVA). The main objective of this study was to evaluate AC incidence in these patients. The secondary objectives were to identify factors associated with AC and to evaluate its impact on the risk of AKI.
This multicentre, observational, cohort study was conducted between Mar 18, 2014 and Aug 16, 2019 in Dijon, Nancy, and Reims University Hospitals as well as Châlon-sur-Saône, Charleville-Mézières, and Troyes general hospitals in France. Adult patients (≥18 years) treated with HDIVA and having been tested for AC at least once during treatment were included. Clinical, biological, and therapeutic characteristics of the patients were collected. A univariable mixed logistic regression model assessed the factors associated with AC. A multivariable Cox model with AC as a time-dependent variable assessed the prognostic factors for AKI. ClinicalTrials.gov number: NCT02853292.
Of the 112 included patients, 27 (24.1%, 95% CI [16.2-32.0]) developed at least one episode of AC within a mean of 5.1 days. The factors associated with its occurrence were the concomitant use of angiotensin converting enzyme (ACE) inhibitors (OR=4.6, 95% CI [2.2-9.3], p<0.0001) and the decrease of urinary pH (OR=2.1 for one pH point decrease, 95% CI [1.2-3.7], p=0.009). 20 patients (17.9%) presented with AKI, within a mean time of 10.9 days. The main factor associated with the occurrence of AKI was the occurrence of AC (aHR=7.4, 95% CI [2.5-22.2], p=0.0003).
AC occurred in a quarter of patients treated with HDIVA and was highly prognostic of AKI.
None.
阿莫西林结晶尿（AC）可能导致急性肾损伤（AKI），在接受大剂量静脉注射阿莫西林（HDIVA）治疗的患者中报告越来越频繁。本研究的主要目的是评估这些患者中AC的发生率。次要目的是确定与AC相关的因素，并评估其对AKI风险的影响。
本多中心、观察性队列研究于2014年3月18日至2019年8月16日在法国第戎、南锡和兰斯大学医院以及索恩河畔沙隆、沙勒维尔-梅济耶尔和特鲁瓦综合医院进行。纳入接受HDIVA治疗且在治疗期间至少进行过一次AC检测的成年患者（≥18岁）。收集患者的临床、生物学和治疗特征。单变量混合逻辑回归模型评估与AC相关的因素。以AC作为时间依赖变量的多变量Cox模型评估AKI的预后因素。ClinicalTrials.gov编号：NCT02853292。
在112例纳入患者中，27例（24.1%，95%CI[16.2 - 32.0]）在平均5.1天内至少发生一次AC。其发生相关因素为同时使用血管紧张素转换酶（ACE）抑制剂（OR = 4.6，95%CI[2.2 - 9.3]，p < 0.0001）和尿液pH值降低（pH值每降低1个单位，OR = 2.1，95%CI[1.2 - 3.7]，p = 0.009）。20例患者（17.9%）出现AKI，平均时间为10.9天。与AKI发生相关的主要因素是AC的发生（aHR = 7.4，95%CI[2.5 - 22.2]，p = 0.0003）。
AC发生在四分之一接受HDIVA治疗的患者中，且对AKI具有高度预后价值。
无。
