万古霉素联用哌拉西林/他唑巴坦致儿童急性肾损伤的系统评价与meta分析

Acute kidney injury induced by vancomycin combined with piperacillin/tazobactam among hospitalized children:a systematic review and meta analysis

目的:系统评价儿童患者万古霉素(vancomycin,VAN)联用哌拉西林/他唑巴坦(piperacillin/tazobactam,TZP)与VAN联用其他β-内酰胺类抗菌药物治疗后急性肾损伤(acute kidney injury,AKI)的发生率,以期为临床治疗提供循证参考。方法:计算机检索Cochrane图书馆、Embase、Pubmed、维普中文科技期刊数据库、中国期刊全文数据库、万方数据库,检索VAN联合TZP与VAN单用或联用其他β-内酰胺类抗菌药物相比AKI发生情况的队列研究,由2位研究者独立筛选文献、提取资料,并依据纽卡斯尔-渥太华质量评估量表(NOS)对纳入文献进行质量评价,采用Rev Man5.3软件进行meta分析。结果:共纳入5篇回顾性队列研究,均为高质量文献(NOS评分均≥8分),涉及2 514例患者,其中VAN联用TZP组1 331例,VAN联用其他β-内酰胺类抗菌药物组1 183例。Meta分析结果显示:联合应用VAN与TZP与VAN单用或者加用其他β-内酰胺类抗菌药物相比可能会提高患儿急性肾损伤的发生风险(OR=4.90,95%CI:2.80~8.43,P<0.01)。结论:联合应用VAN与TZP可能会提高患儿急性肾损伤的发生风险,儿科医生在经验性选用此组合时应关注其可能增加的潜在风险。

Objective： To systematically review the risk of acute kidney injury（AKI） development in children using vancomycin based treatment with piperacillin-tazobactam or other kind of β-lactam drugs. Methods： Electronical databases were searched including the Cochrane library, Pubmed, Embase, VIP, CNKI and Wanfang data, cohort studies were collected if focused on the risks of AKI vancomycin plus piperacillin/tazobactam versus vancomycin alone or plus other β-lactam. Two reviewers independently screened literature, extracted data, and assessed the quality of included studies according to Newcastle-Ottawa Quality Assessment Scale（NOS）. Then, meta-analysis was performed using Rev Man 5.3 software. Results： A total of 5 retrospective cohort studies were included, with a high quality（NOS ≥ 8） and 2 514 patients involved. There were 1 331 cases of vancomycin combined with piperazolin/tazobartan and 1 181 cases of vancomycin alone or plus other β-lactam. The results of meta-analysis showed that, compared with vancomycin alone or plus other beta-lactam, vancomycin plus peracillin/tazobacin might raise the risk of AKI in children（OR=4.90, 95%CI：2.8~8.43, P0.01）. Conclusion： Coadministration of vancomycin and piperacillin/tazobactam may increase the risk of AKI in hospitalized children. Pediatricians must be cognizant of the potential added risk of this combination therapy when making empirical antibiotic choices.