{"title":"万古霉素联合哌拉西林-他唑巴坦与其他β -内酰胺类药物治疗的危重患者急性肾损伤发生率:一项系统综述和荟萃分析","authors":"Ranyi Li, Yanli Li, Chenqi Xu, Ziyan Shen, Xialian Xu, Xiaoqiang Ding, Xiaoyu Li, Qianzhou Lv, Kunming Pan","doi":"10.1177/87551225251350894","DOIUrl":null,"url":null,"abstract":"<p><p><b>Objectives</b>: To explore whether vancomycin (VAN) plus piperacillin-tazobactam (PTZ) was associated with an increased risk of acute kidney injury (AKI) compared with VAN plus other beta-lactams (BLs) or monotherapy in critically ill patients, where the evidence remains controversial. <b>Data sources:</b> PubMed, Cochrane, Web of Science, and Embase were searched from inception to June 2024. <b>Study selection:</b> Studies comparing the risk of AKI with one group receiving VAN+PTZ, and other groups receiving VAN plus other BLs, or monotherapy in critically ill. <b>Data synthesis:</b> This analysis included 20 articles with 28 243 participants. The majority of included studies were retrospective (95%, 19/20) and had moderate risks of bias (80.0%, 16/20). The results indicated VAN+PTZ was associated with a significantly higher risk of AKI compared with VAN plus other BLs (OR = 1.66, 95% CI = 1.42-1.94, <i>P</i> < 0.001). Subgroup analyses showed that compared with adults, children were associated with a higher risk of AKI when receiving VAN+PTZ (OR = 3.16 vs 1.59). Also, VAN+PTZ was associated with a significantly higher risk of severe stage 2 to 3 AKI than VAN plus other BLs (OR = 1.63, 95% CI = 1.28-2.06, <i>P</i> < 0.001). No significant difference was identified in mortality, dialysis, time to AKI, and length of stay between patients receiving VAN plus PTZ and other combinations. <b>Conclusions</b>: In critically ill, VAN plus PTZ was associated with an increased risk of AKI and severe stage 2 to 3 AKI compared with VAN plus other BLs, especially in children. However, more high-quality multicenter, prospective cohort studies, and randomized controlled studies are needed.</p>","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":" ","pages":"87551225251350894"},"PeriodicalIF":1.3000,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301226/pdf/","citationCount":"0","resultStr":"{\"title\":\"Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin With Concomitant Piperacillin-Tazobactam Versus Other Beta-Lactams: A Systematic Review and Meta-Analysis.\",\"authors\":\"Ranyi Li, Yanli Li, Chenqi Xu, Ziyan Shen, Xialian Xu, Xiaoqiang Ding, Xiaoyu Li, Qianzhou Lv, Kunming Pan\",\"doi\":\"10.1177/87551225251350894\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Objectives</b>: To explore whether vancomycin (VAN) plus piperacillin-tazobactam (PTZ) was associated with an increased risk of acute kidney injury (AKI) compared with VAN plus other beta-lactams (BLs) or monotherapy in critically ill patients, where the evidence remains controversial. <b>Data sources:</b> PubMed, Cochrane, Web of Science, and Embase were searched from inception to June 2024. <b>Study selection:</b> Studies comparing the risk of AKI with one group receiving VAN+PTZ, and other groups receiving VAN plus other BLs, or monotherapy in critically ill. <b>Data synthesis:</b> This analysis included 20 articles with 28 243 participants. The majority of included studies were retrospective (95%, 19/20) and had moderate risks of bias (80.0%, 16/20). The results indicated VAN+PTZ was associated with a significantly higher risk of AKI compared with VAN plus other BLs (OR = 1.66, 95% CI = 1.42-1.94, <i>P</i> < 0.001). Subgroup analyses showed that compared with adults, children were associated with a higher risk of AKI when receiving VAN+PTZ (OR = 3.16 vs 1.59). Also, VAN+PTZ was associated with a significantly higher risk of severe stage 2 to 3 AKI than VAN plus other BLs (OR = 1.63, 95% CI = 1.28-2.06, <i>P</i> < 0.001). No significant difference was identified in mortality, dialysis, time to AKI, and length of stay between patients receiving VAN plus PTZ and other combinations. <b>Conclusions</b>: In critically ill, VAN plus PTZ was associated with an increased risk of AKI and severe stage 2 to 3 AKI compared with VAN plus other BLs, especially in children. However, more high-quality multicenter, prospective cohort studies, and randomized controlled studies are needed.</p>\",\"PeriodicalId\":16796,\"journal\":{\"name\":\"Journal of Pharmacy Technology\",\"volume\":\" \",\"pages\":\"87551225251350894\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-07-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301226/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pharmacy Technology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/87551225251350894\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pharmacy Technology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/87551225251350894","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
摘要
目的:探讨万古霉素(VAN)联合哌哌西林-他唑巴坦(PTZ)与VAN联合其他β -内酰胺类药物(BLs)或单药治疗相比,是否与危重患者急性肾损伤(AKI)风险增加相关,目前证据仍存在争议。数据来源:PubMed, Cochrane, Web of Science, Embase从成立到2024年6月。研究选择:比较一组接受VAN+PTZ,另一组接受VAN+其他BLs或危重患者单药治疗的AKI风险的研究。数据综合:本分析包括20篇文章,28 243名参与者。纳入的大多数研究为回顾性研究(95%,19/20),偏倚风险中等(80.0%,16/20)。结果显示,与VAN+其他BLs相比,VAN+PTZ与AKI的风险显著增加(OR = 1.66, 95% CI = 1.42-1.94, P < 0.001)。亚组分析显示,与成人相比,接受VAN+PTZ治疗的儿童发生AKI的风险更高(OR = 3.16 vs 1.59)。此外,VAN+PTZ与严重2 - 3期AKI的风险显著高于VAN+其他BLs (OR = 1.63, 95% CI = 1.28-2.06, P < 0.001)。在接受VAN + PTZ和其他联合治疗的患者之间,死亡率、透析、AKI时间和住院时间没有显著差异。结论:在危重患者中,与VAN +其他BLs相比,VAN + PTZ与AKI和严重2至3期AKI的风险增加相关,尤其是在儿童中。然而,需要更多高质量的多中心、前瞻性队列研究和随机对照研究。
Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin With Concomitant Piperacillin-Tazobactam Versus Other Beta-Lactams: A Systematic Review and Meta-Analysis.
Objectives: To explore whether vancomycin (VAN) plus piperacillin-tazobactam (PTZ) was associated with an increased risk of acute kidney injury (AKI) compared with VAN plus other beta-lactams (BLs) or monotherapy in critically ill patients, where the evidence remains controversial. Data sources: PubMed, Cochrane, Web of Science, and Embase were searched from inception to June 2024. Study selection: Studies comparing the risk of AKI with one group receiving VAN+PTZ, and other groups receiving VAN plus other BLs, or monotherapy in critically ill. Data synthesis: This analysis included 20 articles with 28 243 participants. The majority of included studies were retrospective (95%, 19/20) and had moderate risks of bias (80.0%, 16/20). The results indicated VAN+PTZ was associated with a significantly higher risk of AKI compared with VAN plus other BLs (OR = 1.66, 95% CI = 1.42-1.94, P < 0.001). Subgroup analyses showed that compared with adults, children were associated with a higher risk of AKI when receiving VAN+PTZ (OR = 3.16 vs 1.59). Also, VAN+PTZ was associated with a significantly higher risk of severe stage 2 to 3 AKI than VAN plus other BLs (OR = 1.63, 95% CI = 1.28-2.06, P < 0.001). No significant difference was identified in mortality, dialysis, time to AKI, and length of stay between patients receiving VAN plus PTZ and other combinations. Conclusions: In critically ill, VAN plus PTZ was associated with an increased risk of AKI and severe stage 2 to 3 AKI compared with VAN plus other BLs, especially in children. However, more high-quality multicenter, prospective cohort studies, and randomized controlled studies are needed.
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