万古霉素联合哌拉西林他唑巴坦的急性肾损伤风险:一项倾向性匹配的病例对照研究OA

OBJECTIVE:To probe into the risk of acute kidney injury(AKI)and differences in clinical outcomes in patients treated with vancomycin(VAN)combined with piperacillin-tazobactam(PTZ),cefepime(FEP)or meropenem(MEN).METHODS:Retrospective data on adult inpatients who received VAN combined with PTZ,FEP or MEN for more than 48 hours from Jan.2016 to Dec.2022 were collected.Taking VAN+PTZ as the reference,8 covariates were selected,including gender,age>65 years,VAN daily dose>1 g,treatment duration of VAN>7 d,baseline serum creatinine,sepsis,shock,and concomitant nephrotoxic medications.A 1∶1 porpensity score matching(PSM)was performed between VAN+PTZ and VAN+FEP/MEN group to balance baseline characteristics.Outcomes included AKI incidence,AKI severity(according to KDIGO criteria),in-hospital all-cause mortality,and renal outcomes in patients with AKI.RESULTS:A total of 121 patients were enrolled in the VAN+PTZ group and 3,326 cases were enrolled in the VAN+FEP/MEN group.After PSM,119 patients were included in each group,with balanced baseline characteristics.No statistically significant differences were found in AKI incidence between two groups[21.8%(26/119)vs.18.5%(22/119),P=0.518].The in-hospital mortality was consistent between two groups[4.2%(5/119)],with no significant difference(P=1.000).There were no significant differences in the grading of AKI severity or the rates of improvement/recovery in renal function(P>0.05).The proportion of AKI patients with VAN trough concentration was higher in the VAN+PTZ group than that in VAN+FEP/MEN group[76.9%(20/26)vs.45.5%(10/22),P=0.025].CONCLUSIONS:Compared with VAN+FEP/MEN,VAN+PTZ may not increase the risk of AKI,with similar findings observed for both AKI severity and clinical outcomes.VAN+PTZ can be considered a safe therapeutic option for clinical anti-infective treatment when supported by therapeutic drug monitoring.