The Verdict on Vancomycin and Piperacillin/Tazobactam-Associated Nephrotoxicity: Acquittal by Biomarkers or Guilty as Charged?

IF 3.1 4区 医学 Q2 INFECTIOUS DISEASES
Sara Lee, Emily Heil
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引用次数: 0

Abstract

Purpose of Review

Current literature largely suggests that the combination of vancomycin and piperacillin/tazobactam (VPT) is associated with a significantly higher risk of acute kidney injury (AKI) compared to vancomycin alone or in combination with other antipseudomonal beta-lactams. However, the true mechanisms behind this potential nephrotoxic effect remain unclear.

Recent Findings

The majority of studies describing VPT-associated nephrotoxicity are based on potentially flawed surrogates of glomerular function (e.g., serum creatinine). Moreover, the incidence of creatinine-based AKI is dependent on the consensus definition used. In contrast, animal and clinical studies using more reliable kidney damage biomarkers (e.g., cystatin c) and histopathological examinations largely suggest that injury does not occur.

Summary

In the absence of definitive evidence supported by prospective randomized clinical trials specifically designed to address this question and using various GFR markers and AKI biomarkers, the concern of nephrotoxicity should not influence clinical decision-making for patients requiring broad-spectrum antibiotics. Instead, empiric therapy should be guided by the suspected source of infection, local pathogen susceptibility patterns, and adverse effects.

万古霉素和哌拉西林/他唑巴坦相关肾毒性的判决:生物标志物无罪还是有罪?
综述目的目前的文献大多表明,万古霉素和哌拉西林/他唑巴坦(VPT)联用与单独使用万古霉素或与其他抗伪内酰胺类药物联用相比,发生急性肾损伤(AKI)的风险明显更高。最近的研究结果大多数描述 VPT 相关肾毒性的研究都是基于可能存在缺陷的肾小球功能替代指标(如血清肌酐)。此外,基于肌酐的 AKI 发生率取决于所使用的共识定义。小结在缺乏专门针对这一问题并使用各种 GFR 指标和 AKI 生物标志物的前瞻性随机临床试验支持的确切证据的情况下,对肾毒性的担忧不应影响需要使用广谱抗生素的患者的临床决策。相反,经验性治疗应根据可疑的感染源、当地病原体的易感性模式和不良反应进行指导。
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来源期刊
Current Infectious Disease Reports
Current Infectious Disease Reports INFECTIOUS DISEASES-
CiteScore
6.70
自引率
0.00%
发文量
19
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of infectious disease. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as HIV/AIDS, sexually transmitted diseases, tropical and travel medicine, and urinary tract infections. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists.
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