{"title":"万古霉素联合哌拉西林/他唑巴坦致儿童急性肾损伤的流行病学:系统回顾与元分析》。","authors":"Miao Zhang, Liang Huang, Yu Zhu, Linan Zeng, Zhi-Jun Jia, Guo Cheng, Hailong Li, Lingli Zhang","doi":"10.1177/10600280231220379","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Several studies have shown that vancomycin combined with piperacillin/tazobactam (VPT) increased the risk of acute kidney injury (AKI) compared with other antibiotics in children. However, the epidemiology of VPT-associated AKI in children is unknown.</p><p><strong>Objective: </strong>To evaluate the incidence and risk factors of VPT-associated AKI in children.</p><p><strong>Data sources: </strong>Literature databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, WanFang Database, and China Biology Medicine Disc were searched from inception to November 2023. References of included studies were also manually checked.</p><p><strong>Study selection and data extraction: </strong>Two independent reviewers selected studies, extracted data, and quality assessment. Meta-analyses were performed to quantify the incidence and risk factors of VPT-associated AKI in children.</p><p><strong>Data synthesis: </strong>Sixteen cohort studies were identified. Overall, the incidence of VPT-associated AKI in children was 24.3% (95% CI: 17.9%-30.6%). The incidence of VPT-associated AKI in critically ill children (26.6%) was higher than that in noncritically ill children (10.9%). Moreover, higher serum vancomycin trough concentration (>15 mg/L), use of vasopressors, combination of nephrotoxins and intensive care unit admission were risk factors for VPT-associated AKI in children (<i>P</i> < 0.05).</p><p><strong>Relevance to patient care and clinical practice: </strong>Identifying high-risk groups and determining safer treatments is critical to reducing the incidence of VPT-associated AKI in children.</p><p><strong>Conclusions: </strong>The incidence of VPT-associated AKI in children is high, especially in critically ill children. Medication regimens should be personalized based on the presence of individual risk factors. Moreover, renal function was regularly assessed throughout treatment with VPT.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"1034-1044"},"PeriodicalIF":2.3000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Epidemiology of Vancomycin in Combination With Piperacillin/Tazobactam-Associated Acute Kidney Injury in Children: A Systematic Review and Meta-analysis.\",\"authors\":\"Miao Zhang, Liang Huang, Yu Zhu, Linan Zeng, Zhi-Jun Jia, Guo Cheng, Hailong Li, Lingli Zhang\",\"doi\":\"10.1177/10600280231220379\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Several studies have shown that vancomycin combined with piperacillin/tazobactam (VPT) increased the risk of acute kidney injury (AKI) compared with other antibiotics in children. However, the epidemiology of VPT-associated AKI in children is unknown.</p><p><strong>Objective: </strong>To evaluate the incidence and risk factors of VPT-associated AKI in children.</p><p><strong>Data sources: </strong>Literature databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, WanFang Database, and China Biology Medicine Disc were searched from inception to November 2023. References of included studies were also manually checked.</p><p><strong>Study selection and data extraction: </strong>Two independent reviewers selected studies, extracted data, and quality assessment. Meta-analyses were performed to quantify the incidence and risk factors of VPT-associated AKI in children.</p><p><strong>Data synthesis: </strong>Sixteen cohort studies were identified. Overall, the incidence of VPT-associated AKI in children was 24.3% (95% CI: 17.9%-30.6%). The incidence of VPT-associated AKI in critically ill children (26.6%) was higher than that in noncritically ill children (10.9%). Moreover, higher serum vancomycin trough concentration (>15 mg/L), use of vasopressors, combination of nephrotoxins and intensive care unit admission were risk factors for VPT-associated AKI in children (<i>P</i> < 0.05).</p><p><strong>Relevance to patient care and clinical practice: </strong>Identifying high-risk groups and determining safer treatments is critical to reducing the incidence of VPT-associated AKI in children.</p><p><strong>Conclusions: </strong>The incidence of VPT-associated AKI in children is high, especially in critically ill children. Medication regimens should be personalized based on the presence of individual risk factors. 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引用次数: 0
摘要
背景:多项研究表明,与其他抗生素相比,万古霉素联合哌拉西林/他唑巴坦(VPT)会增加儿童急性肾损伤(AKI)的风险。然而,与 VPT 相关的儿童急性肾损伤的流行病学尚不清楚:评估儿童中 VPT 相关性 AKI 的发生率和风险因素:数据来源:检索了PubMed、Embase、Cochrane图书馆、中国国家知识基础设施(CNKI)、VIP数据库、万方数据库和中国生物医学文献数据库,检索时间从开始至2023年11月。研究的选择和数据提取:两位独立审稿人筛选研究、提取数据并进行质量评估。进行元分析以量化VPT相关儿童AKI的发病率和风险因素:数据综述:共确定了 16 项队列研究。总体而言,儿童 VPT 相关性 AKI 的发生率为 24.3%(95% CI:17.9%-30.6%)。重症儿童的 VPT 相关性 AKI 发生率(26.6%)高于非重症儿童(10.9%)。此外,较高的血清万古霉素谷浓度(>15 mg/L)、使用血管加压药、联合使用肾毒性药物和入住重症监护室也是儿童发生 VPT 相关性 AKI 的风险因素(P 与患者护理和临床实践的相关性):识别高危人群并确定更安全的治疗方法对于降低儿童 VPT 相关性 AKI 的发生率至关重要:儿童 VPT 相关性 AKI 的发生率很高,尤其是在重症儿童中。结论:儿童 VPT 相关性 AKI 的发生率很高,尤其是在重症患儿中,应根据个体风险因素制定个性化的用药方案。此外,在使用 VPT 的整个治疗过程中都要定期评估肾功能。
Epidemiology of Vancomycin in Combination With Piperacillin/Tazobactam-Associated Acute Kidney Injury in Children: A Systematic Review and Meta-analysis.
Background: Several studies have shown that vancomycin combined with piperacillin/tazobactam (VPT) increased the risk of acute kidney injury (AKI) compared with other antibiotics in children. However, the epidemiology of VPT-associated AKI in children is unknown.
Objective: To evaluate the incidence and risk factors of VPT-associated AKI in children.
Data sources: Literature databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, WanFang Database, and China Biology Medicine Disc were searched from inception to November 2023. References of included studies were also manually checked.
Study selection and data extraction: Two independent reviewers selected studies, extracted data, and quality assessment. Meta-analyses were performed to quantify the incidence and risk factors of VPT-associated AKI in children.
Data synthesis: Sixteen cohort studies were identified. Overall, the incidence of VPT-associated AKI in children was 24.3% (95% CI: 17.9%-30.6%). The incidence of VPT-associated AKI in critically ill children (26.6%) was higher than that in noncritically ill children (10.9%). Moreover, higher serum vancomycin trough concentration (>15 mg/L), use of vasopressors, combination of nephrotoxins and intensive care unit admission were risk factors for VPT-associated AKI in children (P < 0.05).
Relevance to patient care and clinical practice: Identifying high-risk groups and determining safer treatments is critical to reducing the incidence of VPT-associated AKI in children.
Conclusions: The incidence of VPT-associated AKI in children is high, especially in critically ill children. Medication regimens should be personalized based on the presence of individual risk factors. Moreover, renal function was regularly assessed throughout treatment with VPT.
期刊介绍:
Annals of Pharmacotherapy (AOP) is a peer-reviewed journal that advances pharmacotherapy throughout the world by publishing high-quality research and review articles to achieve the most desired health outcomes.The articles provide cutting-edge information about the most efficient, safe and cost-effective pharmacotherapy for the treatment and prevention of various illnesses. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 14 days