氨基糖苷类药物对泌尿道感染败血症患者生存率和肾脏结局的影响：一项多中心回顾性研究。

Impact of aminoglycosides on survival rate and renal outcomes in patients with urosepsis: a multicenter retrospective study.

作者信息

Rozenblat David, Serret-Larmande Arnaud, Maillard Alexis, Arrestier Romain, Benghanem Sarah, Charpentier Julien, Darmon Michael, Das Vincent, Dépret François, Donay Jean Luc, Jacquier Hervé, Poupet Hélène, Molina Jean-Michel, Lafaurie Matthieu

机构信息

Service de Maladies infectieuses et Tropicales, Hôpitaux Universitaires Saint-Louis Lariboisière, Assistance Publique - Hôpitaux de Paris, 75010, Paris, France.

Sorbonne Université, Paris, France.

出版信息

Ann Intensive Care. 2025 Apr 12;15(1):52. doi: 10.1186/s13613-025-01469-5.

DOI:10.1186/s13613-025-01469-5

PMID:40216650

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11992283/

Abstract

BACKGROUND

Combination therapy with a beta-lactam and an aminoglycoside is currently recommended for the empirical treatment of urosepsis. Nephrotoxicity is the most common adverse effect of aminoglycosides and acute kidney injury (AKI) has a significant prognostic impact in septic shock. This study aimed to evaluate the impact of empirical antibiotic therapy with or without an aminoglycoside on survival and renal outcomes in patients admitted to the intensive care unit (ICU) with urosepsis.

METHODS

This multicenter, retrospective, comparative study included all adults admitted to the ICU for urinary sepsis or septic shock between January 2015 and May 2022 in four ICUs of three university hospitals within the Assistance Publique-Hôpitaux de Paris (APHP). The primary outcome was mortality on day 30 after ICU admission. Secondary endpoints included the lack of renal recovery, the need for new renal replacement therapy (RRT), the Major Adverse Kidney Events at day 30 (MAKE 30) and ICU length of stay. Confounding by indication was taken into account using propensity score weighting.

RESULTS

A total of 580 patients were included, median age was 69 years (interquartile: 58-77) and 53.6% were male. Overall, 335 patients (57.8%) were in septic shock and 448 (79.2%) had AKI on admission. A total of 579 patients (99.8%) received a beta-lactam as empirical therapy (with (n = 444) or without (n = 136) aminoglycosides). The overall 30-day mortality rate was 10.5% (61/580). After propensity score weighting, the mortality rate in patients receiving aminoglycosides was 7.7% (7/91) compared to 12.1% (11/91) in those not receiving aminoglycosides (adjusted hazard ratio (aHR) = 0.65 [0.35; 1.23], p = 0.19). No significant differences were found in the lack of renal recovery at day 30 (aHR = 0.88 [0.49; 1.58], p = 0.67), the need for new RRT within 30 days (aHR = 1.01 [0.54; 1.88], p = 0.97), MAKE 30 (aHR = 0.94 [0.60; 1.50], p = 0.81), and ICU length of stay among survivors (aHR = 1.07 [0.87; 1.31], p = 0.53).

CONCLUSIONS

Including aminoglycosides in the empirical antibiotic therapy did not significantly improve 30-day survival in patients admitted to the ICU for urosepsis. However, the use of aminoglycosides was not associated with worse renal outcomes.

摘要

背景

目前推荐使用β-内酰胺类药物与氨基糖苷类药物联合治疗来经验性治疗泌尿道感染性败血症。肾毒性是氨基糖苷类药物最常见的不良反应，而急性肾损伤（AKI）对感染性休克的预后有重大影响。本研究旨在评估在入住重症监护病房（ICU）的泌尿道感染性败血症患者中，经验性使用抗生素联合或不联合氨基糖苷类药物对生存和肾脏结局的影响。

方法

这项多中心、回顾性、对照研究纳入了2015年1月至2022年5月期间在巴黎公立医院集团（APHP）下属三家大学医院的四个ICU中因尿源性败血症或感染性休克入住ICU的所有成年患者。主要结局是入住ICU后30天的死亡率。次要终点包括肾功能未恢复、需要进行新的肾脏替代治疗（RRT）、30天时的主要不良肾脏事件（MAKE 30）以及ICU住院时间。使用倾向评分加权法来考虑指征性混杂因素。

结果

共纳入580例患者，中位年龄为69岁（四分位间距：58 - 77岁），男性占53.6%。总体而言，335例患者（57.8%）处于感染性休克状态，448例（79.2%）入院时患有AKI。共有579例患者（99.8%）接受了β-内酰胺类药物作为经验性治疗（联合（n = 444）或不联合（n = 136）氨基糖苷类药物）。总体30天死亡率为10.5%（61/580）。在倾向评分加权后，接受氨基糖苷类药物治疗的患者死亡率为7.7%（7/91），未接受氨基糖苷类药物治疗的患者死亡率为12.1%（11/91）（调整后风险比（aHR）= 0.65 [0.35; 1.23]，p = 0.19）。在30天时肾功能未恢复方面（aHR = 0.88 [0.49; 1.58]，p = 0.67）、30天内需要进行新的RRT方面（aHR = 1.01 [0.54; 1.88]，p = 0.97）、MAKE 30方面（aHR = 0.94 [0.60; 1.50]，p = 0.81）以及幸存者的ICU住院时间方面（aHR = 1.07 [0.87; 1.31]，p = 0.53）均未发现显著差异。