González-Delgado D, Vives M, Monedero P, Aldaz A
Departamento de Anestesiología & Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Universidad de Navarra, Spain.
Departamento de Anestesiología & Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Universidad de Navarra, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
Rev Esp Anestesiol Reanim (Engl Ed). 2025 Feb;72(2):501657. doi: 10.1016/j.redare.2024.501657. Epub 2024 Dec 19.
The independent association of vancomycin with Acute Kidney Injury (AKI) in the critically ill patient with sepsis or septic Shock is controversial. The aim of this study was to evaluate the incidence of AKI in a cohort of patients with sepsis or septic Shock with an adequate and strict monitoring of vancomycin, guided by the area under the concentration-time curve in relation to the minimum inhibitory concentration (AUC/MIC ratio).
Retrospective cohort study on 106 patients admitted to the ICU with a diagnosis of sepsis or septic shock with vancomycin treatment, consecutively from January 2017 to December 2019. AKI was defined according to Kidney Disease Improving Global Outcomes criteria. Risk factors associated with AKI were determined by multivariable logistic regression analysis.
In our cohort, 28 patients out of 106 (26%) developed AKI. ICU and 30-day mortality were 18% and 22%, respectively. After multivariable logistic regression adjusted analysis, chronic liver disease was associated with AKI.
In our retrospective cohort study on critical patients with sepsis and septic shock, treated with vancomycin adjusting the dose guided by a pharmacokinetic/pharmacodynamic monitoring to achieve the target AUC/CMI ratio, the incidence of AKI was 26%.
在患有脓毒症或脓毒性休克的重症患者中，万古霉素与急性肾损伤（AKI）之间的独立关联存在争议。本研究的目的是在一组脓毒症或脓毒性休克患者中，在浓度-时间曲线下面积与最低抑菌浓度之比（AUC/MIC比）的指导下，对万古霉素进行充分且严格的监测，评估AKI的发生率。
对2017年1月至2019年12月期间连续入住ICU且诊断为脓毒症或脓毒性休克并接受万古霉素治疗的106例患者进行回顾性队列研究。根据改善全球肾脏病预后组织的标准定义AKI。通过多变量逻辑回归分析确定与AKI相关的危险因素。
在我们的队列中，106例患者中有28例（26%）发生了AKI。ICU死亡率和30天死亡率分别为18%和22%。经过多变量逻辑回归调整分析后，慢性肝病与AKI相关。
在我们对接受万古霉素治疗的脓毒症和脓毒性休克重症患者进行的回顾性队列研究中，通过药代动力学/药效学监测调整剂量以达到目标AUC/CMI比，AKI的发生率为26%。
