Karas Cassandra, Manning Kyle, Childress Darrell T, Covington Elizabeth W, Manis Melanie M
East Alabama Medical Center, Opelika, AL, USA.
McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA.
J Pharm Technol. 2022 Aug;38(4):218-224. doi: 10.1177/87551225221101736. Epub 2022 Jun 13.
Vancomycin and piperacillin-tazobactam (VPT) is a common antibiotic combination used in hospitals, and there has been increasing data indicating that the combination is associated with increased rates of acute kidney injury (AKI). It is unclear if the dosing method of vancomycin would mitigate the risk of AKI seen with VPT. : To observe and compare incidence of AKI in patients on VPT when using the trough-based dosing method versus the area-under-the-curve (AUC)-based dosing method. : This was a multi-center, retrospective, observational study at 3 community hospitals. Adults receiving at least 48 hours of VPT were included. Patients with severe renal dysfunction, pregnant patients, prisoners, and patients with central nervous system infections, or malignancy were excluded. The primary outcome was incidence of AKI as defined by the Infectious Disease Society of America (IDSA) criteria. A total of 300 patients were included in the study; 150 patients in both the trough and AUC groups. A total of 23 patients (15%) in the trough group and 17 patients (11%) in the AUC group met the primary outcome (odds ratio [OR]: 0.7058, 95% confidence interval [CI]: [0.3603, 1.3826], = .3098). : The incidence of AKI was lower in the AUC group compared with the trough group; however, this was not significant. The results of our study suggest that there is no difference between incidence of AKI when using trough- or AUC-based dosing in those receiving VPT. Because of the small sample size and retrospective nature of the study, more data are needed.
万古霉素与哌拉西林-他唑巴坦（VPT）是医院常用的抗生素组合，越来越多的数据表明该组合与急性肾损伤（AKI）发生率增加有关。目前尚不清楚万古霉素的给药方法是否会降低VPT所致的AKI风险。：观察并比较使用基于谷浓度的给药方法与基于曲线下面积（AUC）的给药方法时，接受VPT治疗的患者中AKI的发生率。：这是一项在3家社区医院进行的多中心、回顾性观察研究。纳入接受至少48小时VPT治疗的成年人。排除严重肾功能不全患者、孕妇、囚犯以及患有中枢神经系统感染或恶性肿瘤的患者。主要结局是根据美国传染病学会（IDSA）标准定义的AKI发生率。该研究共纳入300例患者；谷浓度组和AUC组各150例。谷浓度组共有23例患者（15%）达到主要结局，AUC组有17例患者（11%）达到主要结局（优势比[OR]：0.7058，95%置信区间[CI]：[0.3603，1.3826]，P = 0.3098）。：AUC组的AKI发生率低于谷浓度组；然而，差异无统计学意义。我们的研究结果表明，接受VPT治疗的患者中，使用基于谷浓度或AUC的给药方法时，AKI发生率无差异。由于本研究样本量小且具有回顾性，需要更多数据。
