Clin Infect Dis：一项全国性回顾性队列研究：比较头孢吡肟与哌拉西林-他唑巴坦对脓毒性休克患者发生严重急性肾损伤的影响

Abstract

Background: Cefepime and piperacillin-tazobactam are commonly used broad-spectrum antibiotics used to treat patients with potential gram-negative bacterial sepsis. Piperacillin-tazobactam has been shown to be associated with acute kidney injury (AKI). However, it has not been compared with cefepime in patients with septic shock. We compared the effects of cefepime and piperacillin-tazobactam on the incidence of severe AKI in patients with septic shock.

背景​：头孢吡肟与哌拉西林-他唑巴坦是临床常用的广谱抗生素，用于治疗可能由革兰阴性菌引起的脓毒症。已有研究表明，哌拉西林-他唑巴坦与急性肾损伤（AKI）相关，但其在脓毒性休克患者中的安全性尚未与头孢吡肟进行比较。本研究旨在比较头孢吡肟与哌拉西林-他唑巴坦对脓毒性休克患者严重AKI发生率的影响。

Methods: This was a retrospective, multicenter, inverse probability-of-treatment weighted cohort study conducted in 220 geographically diverse community and teaching hospitals across the United States. Adult patients were included if they had septic shock on hospital admission and received cefepime or piperacillin-tazobactam. The proportions of patients in whom stage 3 AKI occurred during hospitalization were compared between groups.

方法​：本研究为一项回顾性、多中心、治疗逆概率加权队列研究，在美国220家地理分布广泛的社区医院及教学医院开展。纳入标准为住院时确诊脓毒性休克并接受头孢吡肟或哌拉西林-他唑巴坦治疗。比较两组患者住院期间发生3期AKI的比例。

Results: Of the 8427 patients included in the final cohort, 4569 received cefepime and 3858 received piperacillin-tazobactam. Patients had a mean (SD) age of 66.2 (15.2) years, and 45.3% were female; the mean (SD) estimated glomerular filtration rate was 48 (24) mL/min/1.73 m2 on the day of admission. In the weighted cohort, stage 3 AKI occurred in 9.9% receiving cefepime and 9.8% receiving piperacillin-tazobactam (odds ratio, 0.98 [95% confidence interval, .84-1.15]; P = .82). In terms of secondary outcomes, there was no significant difference between cefepime and piperacillin-tazobactam with regard to renal replacement therapy, in-hospital death, major adverse kidney events, stage 1 AKI, stage 2 AKI, maximum recorded serum creatinine, or hospital length of stay.

结果​：最终队列共纳入8,427例患者，其中4,569例接受头孢吡肟治疗，3,858例接受哌拉西林-他唑巴坦治疗。患者平均年龄（标准差）为66.2（15.2）岁，女性占45.3%；入院当日估算肾小球滤过率平均值为48（24）mL/min/1.73 m²。经加权分析，头孢吡肟组与哌拉西林-他唑巴坦组发生3期AKI的比例分别为9.9%和9.8%（比值比0.98 [95%置信区间0.84-1.15]；P=0.82）。次要结局方面，两组在肾脏替代治疗、住院死亡率、重大不良肾脏事件、1期AKI、2期AKI、最高记录血清肌酐值及住院时长等方面均无显著差异。

Conclusions: Among hospitalized patients with septic shock, there was no difference between cefepime and piperacillin-tazobactam in the occurrence of severe AKI.

结论​：在脓毒性休克住院患者中，头孢吡肟与哌拉西林-他唑巴坦在严重AKI发生风险方面无显著差异。