万古霉素联合哌西林-他唑巴坦与急性肾损伤的关系:区分假损伤与真肾毒性

IF 2.8 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL
Congqin Chen, Rijing Zhou, Jie Fang, Jie Xiao
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引用次数: 0

摘要

万古霉素联合哌西林-他唑巴坦(VPT)广泛用于严重感染,但其潜在的协同肾毒性仍存在争议。本研究通过AERSMine使用FDA不良事件报告系统(FAERS)数据库来评估VPT和万古霉素加碳青霉烯类药物(VC)的AKI风险,并与其他基于万古霉素的方案进行比较,以评估假肾毒性与真肾毒性的假设。歧化分析采用报告比值比(ROR)和贝叶斯置信传播神经网络(BCPNN)进行。模型1包括所有与万古霉素相关的报告,而模型2则集中于医疗专业人员的报告。在模型1中,检测到总体AKI的安全信号(ROR: 1.31, 95% CI: 1.26-1.37;IC025: 0.21)和肌酐变化(ROR: 1.23, 95% CI: 1.10-1.38;IC025: 0.12)与VPT。相比之下,其他生物标志物的变化未观察到显著的歧化信号(ROR: 0.89, 95% CI: 0.70-1.14;IC025:−0.38),重度AKI (ROR: 0.82, 95% CI: 0.76-0.89;IC025:−0.31),或开始肾脏替代治疗(RRT) (ROR: 1.08, 95% CI: 0.90-1.29;IC025:−0.09)。在所有亚组中,VC与其他含万古霉素的方案相比,未检测到AKI风险增加的安全信号。模型2证实了这一趋势。这些研究结果表明肌酐定义的AKI伴VPT可能代表假毒性而不是真正的肾毒性。需要进一步的研究来阐明VPT的安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Association of Vancomycin Plus Piperacillin-Tazobactam With Acute Kidney Injury: Differentiating Pseudo-Injury From True Nephrotoxicity

Association of Vancomycin Plus Piperacillin-Tazobactam With Acute Kidney Injury: Differentiating Pseudo-Injury From True Nephrotoxicity

The combination of vancomycin and piperacillin-tazobactam (VPT) is widely used for severe infections, but its potential synergistic nephrotoxicity remains debated. This study used the FDA Adverse Event Reporting System (FAERS) database via AERSMine to assess the risk of AKI with VPT and vancomycin plus carbapenems (VC), compared to other vancomycin-based regimens to evaluate the hypothesis of pseudo-nephrotoxicity versus true nephrotoxicity. Disproportionality analysis was performed using the reporting odds ratio (ROR) and Bayesian confidence propagation neural network (BCPNN). Model 1 included all vancomycin-associated reports, while Model 2 focused on reports from healthcare professionals. In Model 1, a safety signal was detected for overall AKI (ROR: 1.31, 95% CI: 1.26–1.37; IC025: 0.21) and changes in creatinine (ROR: 1.23, 95% CI: 1.10–1.38; IC025: 0.12) with VPT. In contrast, no significant disproportionality signal was observed for changes in other biomarkers (ROR: 0.89, 95% CI: 0.70–1.14; IC025: −0.38), severe AKI (ROR: 0.82, 95% CI: 0.76–0.89; IC025: −0.31), or renal replacement therapy (RRT) initiation (ROR: 1.08, 95% CI: 0.90–1.29; IC025: −0.09). No safety signal of increased risk of AKI was detected for VC versus other vancomycin-containing regimens across all subgroups. Model 2 confirmed this trend. These findings suggest that creatinine-defined AKI with VPT may represent pseudotoxicity rather than true nephrotoxicity. Further research is needed to clarify the safety profile of VPT.

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来源期刊
Cts-Clinical and Translational Science
Cts-Clinical and Translational Science 医学-医学:研究与实验
CiteScore
6.70
自引率
2.60%
发文量
234
审稿时长
6-12 weeks
期刊介绍: Clinical and Translational Science (CTS), an official journal of the American Society for Clinical Pharmacology and Therapeutics, highlights original translational medicine research that helps bridge laboratory discoveries with the diagnosis and treatment of human disease. Translational medicine is a multi-faceted discipline with a focus on translational therapeutics. In a broad sense, translational medicine bridges across the discovery, development, regulation, and utilization spectrum. Research may appear as Full Articles, Brief Reports, Commentaries, Phase Forwards (clinical trials), Reviews, or Tutorials. CTS also includes invited didactic content that covers the connections between clinical pharmacology and translational medicine. Best-in-class methodologies and best practices are also welcomed as Tutorials. These additional features provide context for research articles and facilitate understanding for a wide array of individuals interested in clinical and translational science. CTS welcomes high quality, scientifically sound, original manuscripts focused on clinical pharmacology and translational science, including animal, in vitro, in silico, and clinical studies supporting the breadth of drug discovery, development, regulation and clinical use of both traditional drugs and innovative modalities.
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