万古霉素联合哌拉西林-他唑巴坦钠致重症患者急性肾损伤的Meta分析

Meta-Analysis of Acute Kidney Injury in Critically Ill Patients Caused by Vancomycin Combined with Piperacillin-Tazobactam Sodium

目的:通过系统评价探讨万古霉素联合哌拉西林-他唑巴坦钠致重症患者急性肾损伤(acute kidney injury,AKI)的发生情况,为临床抗菌药物的合理使用提供参考。方法:以万古霉素(vancomycin)、哌拉西林-他唑巴坦钠(piperacillin-tazobactam sodium)、急性肾损伤(acute kidney injury)、肾毒性(nephrotoxicity)等为关键词,在PubMed、Embase、中国知网、重庆维普、万方数据库等中外数据库,检索万古霉素联合哌拉西林-他唑巴坦钠致重症患者AKI的队列研究文献,分析患者AKI和病亡的发生情况。结果:以纳排标准对最初检索到的6 683篇文献进行进一步筛选,最终筛得符合要求的文献10篇,共涉及患者4 094例,其中万古霉素联合哌拉西林-他唑巴坦钠者2 350例,而万古霉素联合其他β-内酰胺类药物者1 744例;Meta分析结果显示,万古霉素联合哌拉西林-他唑巴坦者的AKI发生率高于万古霉素联合其他β-内酰胺类药物者(25.40%vs 10.55%,P<0.05);而万古霉素联合哌拉西林-他唑巴坦者的死亡率略低于万古霉素联合其他β-内酰胺类药物者(13.67%vs 19.54),但其差异经比较无统计学意义(P>0.05)。结论:万古霉素与哌拉西林-他唑巴坦钠联用可能会提高重症患者AKI的发生风险,临床在进行抗菌药物联合使用时应关注此类潜在风险,以减少此类不良事件的发生,保障患者的用药安全。

Objective:To explore the occurrence of acute kidney injury(AKI) in critically ill patients caused by vancomycin combined with piperacillin-tazobactam sodium through systematic evaluation,and to provide reference for rational use of antibacterial drugs in clinical practice.Methods:With key words such as vancomycin,piperacillintazobactam sodium,acute kidney injury,and nephrotoxicity,literature on the cohort study of AKI in critically ill patients induced by vancomycin combined with piperacillin-tazobactam sodium was searched in Chinese and foreign databases such as PubMed,Embase,CNKI,Chongqing VIP,and Wanfang Databases,and the occurrence of AKI and mortality in patients was analyzed.Results:6 683 initially retrieved articles were further screened using the inclusion and exclusion criteria,resulting in 10 articles that met the requirements,involving a total of 4 094 patients,including 2 350 cases of patients taking vancomycin combined with piperacillin-tazobactam sodium,and 1 744 cases of patients taking vancomycin combined with other β-lactam drugs.The meta-analysis results showed that the incidence rate of AKI in patients taking vancomycin combined with piperacillin-tazobactam was higher than that in patients taking vancomycin combined with other β-lactam drugs(25.40% vs 10.55%,P<0.05).The mortality rate of patients taking vancomycin combined with piperacillin-tazobactam was slightly lower than that of patients taking vancomycin combined with other β-lactam drugs(13.67% vs 19.54%),but the difference was not statistically significant by comparison(P>0.05).Conclusion:The combination of vancomycin and piperacillin-tazobactam sodium may increase the risk of AKI in critically ill patients.Therefore,clinical attention should be paid to this potential risk when using antibacterial drugs in combination to reduce the occurrence of such adverse events and ensure the medication safety of patients.