Acute Kidney Injury Associated with the Concomitant Use of Vancomycin and Piperacillin-Tazobactam.

IF 5.1 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2025-09-09 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S524370

Dayu Chen, Jingjing Kan, Qiaoling Gu, Yi-Chen Li, Yunxing Liu, Mengzhu Kong, Jinchun Liu, Haixia Zhang

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Abstract

In recent years, the increased use of vancomycin (VAN) in combination with piperacillin-tazobactam (TZP) has raised significant concerns in clinical practice regarding the heightened risk of acute kidney injury (AKI). This topic has become a focal point in clinical therapeutics due to the widespread application of VAN alongside TZP. The specific mechanisms underlying vancomycin and piperacillin-tazobactam (VPT) associated AKI remain unclear. In this review, we discuss several controversial or underexplored aspects of current research. While the majority of literature links VPT to an elevated risk of AKI, numerous studies present conflicting outcomes. Mechanisms proposed for the increased risk of AKI associated with VPT, based on clinical observations and animal studies, include additive toxic effects, increased VAN exposure due to concomitant use with TZP, exacerbated VAN-induced oxidative stress injury in proximal renal tubule by TZP, pseudo-nephrotoxicity mediated by VPT-induced impaired creatinine secretion, or a combination of the aforementioned mechanisms. Additionally, this review outlines potential strategies that might effectively mitigate the risk of VPT-induced AKI, offering insights and future implications in the realm of pharmacovigilance.

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万古霉素和哌拉西林-他唑巴坦联合使用的急性肾损伤

近年来，万古霉素（VAN）与哌拉西林-他唑巴坦（TZP）联合使用的增加引起了临床实践中对急性肾损伤（AKI）风险增加的重大关注。由于VAN与TZP的广泛应用，这一主题已成为临床治疗学的焦点。万古霉素和哌拉西林-他唑巴坦（VPT）相关AKI的具体机制尚不清楚。在这篇综述中，我们讨论了当前研究中几个有争议或未充分开发的方面。虽然大多数文献将VPT与AKI风险升高联系起来，但许多研究提出了相互矛盾的结果。基于临床观察和动物研究，提出了与VPT相关的AKI风险增加的机制，包括附加毒性作用，由于与TZP同时使用而增加的VAN暴露，TZP加重了VAN诱导的近端肾小管氧化应激损伤，由VPT诱导的肌酸酐分泌受损介导的伪肾毒性，或上述机制的组合。此外，本综述概述了可能有效降低vpt诱导AKI风险的潜在策略，为药物警戒领域提供了见解和未来的意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.