中国医院用药评价与分析2026，Vol.26Issue(5)：524-528,5.DOI:10.14009/j.issn.1672-2124.2026.05.003
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
Risk of Acute Kidney Injury Associated with the Combination of Vancomycin and Piperacillin-Tazobactam:a Propensity Score-Matched Case-Control Study
摘要
Abstract
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.关键词
万古霉素/哌拉西林他唑巴坦/美罗培南/头孢吡肟/急性肾损伤Key words
Vancomycin/Piperacillin tazobactam/Meropenem/Cefepime/Acute kidney injury分类
医药卫生引用本文复制引用
左成淳,张颖,王玉珠,吕迁洲,潘坤明,李晓宇..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[J].中国医院用药评价与分析,2026,26(5):524-528,5.基金项目
国家自然科学基金资助项目(No.82204520) （No.82204520）
上海市卫生健康委员会(No.20244Y0101) （No.20244Y0101）
上海市青年医学人才-临床药师项目[No.SHWSRS(2023)_106] （2023）
吴阶平医学基金会(No.320.6750.2024-18-12) （No.320.6750.2024-18-12）
