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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Identification of Risk. Factors for Nephrotoxicity in Patients Receiving Extended-Duration, High-Trough Vancomycin Therapy
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Identification of Risk. Factors for Nephrotoxicity in Patients Receiving Extended-Duration, High-Trough Vancomycin Therapy

机译：风险识别。接受持续时间高波万古霉素治疗的患者肾毒性的因素

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Background: In the past, impurities in vancomycin formulations were thought to contribute to nephrotoxicity. In contrast, when current, purer formulations are dosed at conventional trough levels (i.e., 5-15 mg/L), the incidence of nephrotoxicity is relatively low. Recent guidelines have recommended targeting higher vancomycin trough levels in treatment of complicated methicillin-resistant Staphylococcus aureus infections. Dosing based on these higher trough levels may be associated with nephrotoxicity, so the potential risk factors for vancomycin-associated nephrotoxicity require clearer definition. Objectives: To determine the occurrence of nephrotoxicity in patients receiving more than 7 days of vancomycin therapy with high trough levels (15-20 mg/L) and to identify and evaluate specific risk factors related to development of vancomycin-associated nephrotoxicity (i.e., serum creatinine > 44.2 umol/L or increase > 50% [i.e., > 26.2 umol/L] from baseline on 2 consecutive days). Methods: Health care records were reviewed for patients seen at 2 major teaching hospitals between January 2008 and March 2011. Patients who had attained high trough levels of vancomycin were screened for eligibility. Patients with unstable renal function, those undergoing hemodialysis, and those for whom dosage and/or sampling times were unclear were excluded. Univariate and multivariate analyses were performed to identify risk factors associated with nephrotoxicity. Univariate variables with/; < 0.1 were included in the logistic regression model. Results: Of the 176 patients with high trough levels included in the analysis, 24 (14%) experienced nephrotoxicity. In univariate analysis, admission to a general medicine unit (the setting of care for 16 [67%] of the 24 patients with nephrotoxicity) and extended duration of vancomycin treatment were identified as risk factors for nephrotoxicity (p < 0.1). Other risk factors included gastrointestinal comorbidity (p = 0.056), malignancy (p = 0.044), and febrile neutropenia (p = 0.032). Multivariate analysis identified treatment on general medicine units and treatment courses longer than 7 days as independent predictors of vancomycin-associated nephrotoxicity. Conclusion: Patients being treated on general medicine units and those receiving vancomycin for more than 7 days had an increased likelihood of experiencing nephrotoxicity. The increased risk for patients on general medicine units is likely multifactorial. The relationship between treatment duration and risk of nephrotoxicity appeared to be linear. When using extended-duration, high-trough vancomycin therapy, clinicians should be vigilant in monitoring for nephrotoxicity.
机译：背景：过去，万古霉素制剂中的杂质被认为会造成肾毒性。相反，当以常规的低谷水平（即5-15mg / L）计量当前较纯的制剂时，肾毒性的发生率相对较低。最近的指南建议针对更高的万古霉素谷水平治疗复杂的耐甲氧西林金黄色葡萄球菌感染。基于这些较高谷水平的给药可能与肾毒性有关，因此与万古霉素相关的肾毒性的潜在危险因素需要更明确的定义。目的：确定在高谷水平（15-20 mg / L）接受万古霉素治疗超过7天的患者中发生肾毒性的发生，并鉴定和评估与万古霉素相关肾毒性发展有关的特定危险因素（即血清）连续2天肌酐> 44.2 umol / L或比基线增加> 50％[即> 26.2 umol / L]。方法：对2008年1月至2011年3月在两家主要教学医院就诊的患者的医疗记录进行回顾。筛选出万古霉素高谷水平患者。排除肾功能不稳定的患者，进行血液透析的患者以及不清楚剂量和/或采样时间的患者。进行单因素和多因素分析以鉴定与肾毒性相关的危险因素。带/的单变量<0.1包括在逻辑回归模型中。结果：在分析中包括的176例高谷水平患者中，有24例（14％）经历了肾毒性。在单变量分析中，入院普通科室（24名肾毒性患者中有16名[67％]接受护理）和万古霉素治疗时间的延长被确定为肾毒性的危险因素（p <0.1）。其他危险因素包括胃肠道合并症（p = 0.056），恶性肿瘤（p = 0.044）和发热性中性粒细胞减少（p = 0.032）。多变量分析确定，普通药物治疗和超过7天的疗程是万古霉素相关肾毒性的独立预测因子。结论：接受普通药物治疗的患者和接受万古霉素治疗超过7天的患者发生肾毒性的可能性增加。接受普通药物治疗的患者风险增加可能是多因素的。治疗持续时间和肾毒性风险之间的关系似乎是线性的。当采用持续时间高的万古霉素治疗时，临床医生应保持警惕以监测肾毒性。

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