Retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients 英文参考文献.docVIP

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Retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients 英文参考文献.doc

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Retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients 英文参考文献

Spapenetal.AnnalsofIntensiveCare2011,1:26 /content/1/1/26 RESEARCH OpenAccess Retrospectiveevaluationofpossiblerenaltoxicity associatedwithcontinuousinfusionof vancomycinincriticallyillpatients HerbertDSpapen1*,KarinJanssenvanDoorn2,MarcDiltoer1,WalterVerbrugghe3,RitaJacobs1,NadiaDobbeleir1, PatrickMHonoré1andPhilippeGJorens3 Abstract Background:Continuousinfusionofvancomycinisincreasinglypreferredasanalternativetointermittent administrationincriticallyillpatients.Intermittentvancomycintreatmentisassociatedwithanincreased occurrenceofnephrotoxicity.Thisstudywasdesignedtodeterminetheincidenceandriskfactorsofacutekidney injury(AKI)duringcontinuousinfusionofvancomycin. Methods:Thiswasaretrospective,observational,two-center,cohortstudyinpatientswithmicrobiologically documentedGram-positivepneumoniaand/orbacteremiaandnormalbaselinerenalfunction.Vancomycindose wasadjusteddailyaimingatplateauconcentrationsof15-25μg/mL.AKIwasdefinedasanincreaseinserum creatinineof0.3mg/dLora1.5to2timesincreasefrombaselineonatleast2consecutivedaysaftertheinitiationof vancomycin.PrimarydataanalysiscomparedpatientswithAKIwithpatientswhodidnotdevelopAKI.Abinary logisticregressionanalysisusingtheforwardstepwisemethodwasusedtoassesstheriskfactorsassociatedwithAKI. Results:Atotalof129patientswerestudiedofwhom38(29.5%)developedAKI.PatientswithAKIhadhigher bodyweight(77.3±15vs.70.5±15.2kg;p=0.02),morediabetes(79%vs.54%;p=0.01),andahigher vasopressorneed(87%vs.59%;p=0.002).Serumvancomycinlevels,bodyweight,andSAPS3scorewere identifiedasvariablescontributingtoAKI.TheincidenceofAKIincreasedsubstantiallywhentreatmentduration wasprolonged(14.9±9.8vs.9.2±4.9days;p=0.05)andplasmalevelsexceeded30μg/mL. Conclusions:AKIisfrequentlyobservedduringcontinuousvancomycininfusion,particularlywhenconditionsthat causeacute(shock)orchronic(diabetes)renaldysfunctionarepresentandvancomycinlevelsabovetargetrange areachieved.Althoughthisstudychallengestheconceptthatcontinuousvancomycininfusionmightalleviatethe riskofnephr