小児におけるバンコマイシンとタゾバクタム／ピペラシリンの単独および併用投与時における腎機能への影響評価

―単施設後方視的研究―

抄録

Tazobactam/piperacillin (TAZ/PIPC) is a broad-spectrum antibiotic with anti-pseudomonal activity. Vancomycin (VCM) is primarily active against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus. These drugs are commonly used together as broad empirical therapy for hospitalized patients with Pseudomonas aeruginosa infections, catheter-associated infection and sepsis.

There have been several recent reports of increased nephrotoxicity associated with the concomitant use of VCM and TAZ/PIPC in adults. Our objective is to determine whether the addition of TAZ/PIPC leads to an increased incidence of nephrotoxicity in pediatric patients receiving VCM and to explore potential confounding factors of acute kidney injury (AKI).

We conducted a retrospective study to assess the incidence of AKI in pediatric patients treated with VCM alone, TAZ/PIPC alone or concomitant use (120 cases in each group). AKI was defined as an increase in serum creatinine (SCr) > 50% in serial creatinine measurements and indicates abnormal SCr level.

Fifteen (VCM), 6 (TAZ/PIPC) and 30 (concomitant use) patients met the criteria for AKI and the SCr increase rates were 38.2%, 34.8% and 61.7%. Long duration of therapy and high VCM trough levels were observed in patients with AKI. The incidence of VCM-related AKI was commonly associated with > 1% of fractional excretion rate of sodium, hyponatremia, hyperkalemia, metabolic acidosis and < 20 of blood urea nitrogen/SCr ratio, suggesting that AKI results from renal tubular injury.

We observed an increased incidence of AKI in pediatric patients with concomitant use of VCM and TAZ/PIPC, and require pharmaceutical management based on laboratory data.