Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
Ann Pharmacother. 2024 Oct;58(10):1034-1044. doi: 10.1177/10600280231220379. Epub 2024 Jan 27.
Several studies have shown that vancomycin combined with piperacillin/tazobactam (VPT) increased the risk of acute kidney injury (AKI) compared with other antibiotics in children. However, the epidemiology of VPT-associated AKI in children is unknown.
To evaluate the incidence and risk factors of VPT-associated AKI in children.
Literature databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, WanFang Database, and China Biology Medicine Disc were searched from inception to November 2023. References of included studies were also manually checked.
Two independent reviewers selected studies, extracted data, and quality assessment. Meta-analyses were performed to quantify the incidence and risk factors of VPT-associated AKI in children.
Sixteen cohort studies were identified. Overall, the incidence of VPT-associated AKI in children was 24.3% (95% CI: 17.9%-30.6%). The incidence of VPT-associated AKI in critically ill children (26.6%) was higher than that in noncritically ill children (10.9%). Moreover, higher serum vancomycin trough concentration (>15 mg/L), use of vasopressors, combination of nephrotoxins and intensive care unit admission were risk factors for VPT-associated AKI in children ( < 0.05).
Identifying high-risk groups and determining safer treatments is critical to reducing the incidence of VPT-associated AKI in children.
The incidence of VPT-associated AKI in children is high, especially in critically ill children. Medication regimens should be personalized based on the presence of individual risk factors. Moreover, renal function was regularly assessed throughout treatment with VPT.
多项研究表明，与其他抗生素相比，万古霉素联合哌拉西林/他唑巴坦（VPT）增加了儿童发生急性肾损伤（AKI）的风险。然而，儿童 VPT 相关性 AKI 的流行病学情况尚不清楚。
评估儿童 VPT 相关性 AKI 的发生率和危险因素。
检索了 PubMed、Embase、Cochrane 图书馆、中国知网（CNKI）、维普数据库、万方数据库和中国生物医学文献数据库，检索时间从建库至 2023 年 11 月。还手动检查了纳入研究的参考文献。
两名独立的审查员选择研究、提取数据和进行质量评估。进行荟萃分析以量化儿童 VPT 相关性 AKI 的发生率和危险因素。
共纳入 16 项队列研究。总体而言，儿童 VPT 相关性 AKI 的发生率为 24.3%（95%CI：17.9%-30.6%）。危重症儿童（26.6%）VPT 相关性 AKI 的发生率高于非危重症儿童（10.9%）。此外，较高的万古霉素谷浓度（>15mg/L）、使用血管加压药、肾毒性药物联合使用和入住重症监护病房是儿童 VPT 相关性 AKI 的危险因素（ < 0.05）。
确定高危人群并确定更安全的治疗方法对于降低儿童 VPT 相关性 AKI 的发生率至关重要。
儿童 VPT 相关性 AKI 的发生率较高，尤其是在危重症儿童中。应根据个体危险因素制定个体化的治疗方案。此外，在 VPT 治疗过程中应定期评估肾功能。
