Memiş Hasan, Çakır Ahmet, Pehlivanlı Aysel, Başgut Bilgen
University of Health Sciences Konya Beyhekim Training and Research Hospital, Konya, Türkiye.
Department of Clinical Pharmacy, İnonu University School of Pharmacy, Malatya, Türkiye.
Infect Dis Clin Microbiol. 2025 Jun 26;7(2):123-132. doi: 10.36519/idcm.2025.504. eCollection 2025 Jun.
Augmented renal clearance (ARC), defined as rapid drug clearance, can lead to subtherapeutic antimicrobial concentrations in specific patient populations. This scoping review aimed to synthesize current evidence on ARC in adult patients receiving antimicrobial treatment, focusing on its prevalence, risk factors, and influence on attaining therapeutic drug levels. It also identified gaps for future research and provided dosage recommendations.
This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for Scoping Reviews (PRISMA-ScR) reporting guidelines. The titles, abstracts, and keywords of the studies indexed in Web of Science, PubMed, or Scopus between 2019 and 2023 were extensively analyzed for relevance to ARC and antimicrobial therapy. Non-English articles, reviews, and non-human studies were excluded. Data extracted included article type, study details, patient population, ARC definition, ARC prevalence, methods of renal function assessment, and study results.
Of 492 articles identified, 47 met the inclusion criteria, covering a total of 6193 patients. ARC prevalence in the studies ranged from 3.3% to 100%. The Cockcroft-Gault equation was the most commonly used method for calculating creatinine clearance (66%). Risk factors for ARC were reported in 8.5% of the studies, and glycopeptides were the most frequently examined drug class (31.9%). In 26 (55.3%) studies, high doses or prolonged infusions were recommended to achieve therapeutic drug levels.
β-lactams and linezolid may require prolonged infusion or higher doses in ARC patients, while glycopeptides and aminoglycosides may also require higher doses. Further research is needed to clarify how ARC affects clinical outcomes and dosing strategies.
增强肾清除率（ARC）被定义为药物快速清除，可导致特定患者群体中抗菌药物浓度低于治疗水平。本综述旨在综合目前接受抗菌治疗的成年患者中ARC的现有证据，重点关注其患病率、危险因素以及对达到治疗药物水平的影响。它还确定了未来研究的空白并提供了剂量建议。
本综述遵循系统评价和Meta分析扩展综述的首选报告项目（PRISMA-ScR）报告指南。对2019年至2023年期间在科学网、PubMed或Scopus中索引的研究的标题、摘要和关键词进行了广泛分析，以确定其与ARC和抗菌治疗的相关性。排除非英文文章、综述和非人体研究。提取的数据包括文章类型、研究细节、患者群体、ARC定义、ARC患病率、肾功能评估方法和研究结果。
在鉴定出的492篇文章中，47篇符合纳入标准，共涵盖6193名患者。研究中的ARC患病率在3.3%至100%之间。Cockcroft-Gault方程是计算肌酐清除率最常用的方法（66%）。8.5%的研究报告了ARC的危险因素，糖肽类是最常研究的药物类别（31.9%）。在26项（55.3%）研究中，建议采用高剂量或延长输注时间以达到治疗药物水平。
在ARC患者中，β-内酰胺类和利奈唑胺可能需要延长输注时间或更高剂量，而糖肽类和氨基糖苷类可能也需要更高剂量。需要进一步研究以阐明ARC如何影响临床结局和给药策略。
