剂量策略的修改 (AUC或低谷) 对与米素与皮佩拉西林/塔扎巴克坦或塞菲皮姆和美罗胺结合的AKI的影响
Breanne Mefford1,2, Katie L Wallace1,2, J Chris Donaldson1,2
1Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA.
Antimicrobial agents and chemotherapy
|April 12, 2024
概括
与塞费皮姆/美罗烯姆相比,使用皮佩拉西林-塔扎巴克坦 (TZP) 与万科米辛 (VAN) 增加了急性损伤 (AKI) 的风险. 范科米辛的监测策略 (AUC与低谷) 并没有改变这种AKI风险. 在不同组中,MAKE-30的结果是相似的.
科学领域:
- 药理学 药理学是指药理学的学科.
- 腎臟病學 (nephrology) 是一種醫學.
- 关键护理医学 关键护理医学
背景情况:
- 皮佩拉西林-塔扎巴克坦 (TZP) 和万科米辛 (VAN) 经常用于败血症.
- 研究表明,TZP和VAN增加了急性损伤 (AKI) 的风险,而非塞费皮姆 (FEP) 或美罗 (MEM).
- 目前的VAN指南建议在曲线下面积 (AUC) 监测低谷 (Tr) 以减轻AKI风险.
研究的目的:
- 调查AKI和30天多项损伤 (MAKE-30) 与VAN监测策略 (AUC与Tr) 的关联.
- 为了比较这些结果,当VAN与TZP相结合时,与FEP/MEM相比.
主要方法:
- 在2015-2019年期间接受VAN超过72小时的成年患者的回顾性研究.
- 排除标准包括先前存在的AKI或低基线肌素清除率 (CrCl).
- 分析了四个队列:FEP/MEM与Tr或AUC监测,以及TZP与Tr或AUC监测. 使用了考克斯比例危险模型和多变量物流回归.
主要成果:
- 整体AKI发生率为18.6%.
- 与FEP/MEM组 (14.6% Tr,14.9% AUC) 相比,在TZP组 (26% Tr,17.1% AUC) 中观察到更高的AKI率.
- 药物选择 (TZP) 和监测策略 (Tr) 都与AKI显著相关,但没有发现相互作用效应. MAKE-30的结果在各个队伍中没有显著差异.
结论:
- 皮佩拉西林 - 塔扎巴克坦的使用,无论康胺的监测策略,都与急性损伤的风险更高有关.
- 范科米辛的监测策略 (AUC与低谷) 在与piperacillin-tazobactam一起使用时没有改变AKI的风险.
- 在所有治疗和监测策略组中,MAKE-30的结果是可比的.
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