Amikacin treatment in urinary tract infection patients: evaluating the risk of acute kidney injury - a retrospective cohort study.

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES Journal of Chemotherapy Pub Date : 2024-09-01 Epub Date: 2024-02-19 DOI:10.1080/1120009X.2024.2319454

Avner Dagan, Danny Epstein, Ami Neuberger, Jonathan Isenberg

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Abstract

The rise in ESBL-producing and carbapenem-resistant Gram-negative bacterial infections is alarming. Aminoglycosides remain attractive for treating urinary tract infections (UTIs). However, aminoglycosides-associated acute kidney injury (AKI) raises concerns, especially in patients with underlying renal impairment. We conducted a retrospective cohort study to evaluate the risk of AKI in patients with UTI empirically treated with amikacin. Among 395 patients (median age 41.9 years [IQR 28.3-67.1], 342 [86.6%] female), 162 (41.0%) received amikacin and 233 (59.0%) were empirically treated with other antibiotics. AKI incidence was low (5.6%) and not associated with amikacin exposure (OR 0.56, 95% CI 0.22-1.43, p = 0.23), even in those with pre-existing renal impairment or AKI on admission. The clinical outcomes (including cure by the third day, AKI, maximal creatinine, length of stay, mortality, and readmission) did not differ between the groups. Once-daily amikacin may offer a safe UTI treatment option amid increasing multi-drug resistance.

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尿路感染患者的阿米卡星治疗：评估急性肾损伤的风险--一项回顾性队列研究。

产 ESBL 和耐碳青霉烯革兰阴性菌感染的增加令人担忧。氨基糖苷类药物在治疗尿路感染（UTI）方面仍然具有吸引力。然而，氨基糖苷类药物引起的急性肾损伤（AKI）令人担忧，尤其是在有潜在肾功能损害的患者中。我们进行了一项回顾性队列研究，以评估阿米卡星经验性治疗的UTI患者发生AKI的风险。在 395 名患者（中位年龄 41.9 岁 [IQR 28.3-67.1]，342 [86.6%] 女性）中，162 人（41.0%）接受了阿米卡星治疗，233 人（59.0%）接受了其他抗生素的经验性治疗。AKI 发生率较低（5.6%），且与阿米卡星暴露无关（OR 0.56，95% CI 0.22-1.43，p = 0.23），即使入院时已有肾功能损害或 AKI 的患者也是如此。两组患者的临床结果（包括第三天治愈率、AKI、最大肌酐、住院时间、死亡率和再入院率）并无差异。在多重耐药性不断增加的情况下，每日一次的阿米卡星可能是一种安全的UTI治疗选择。

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来源期刊

Journal of Chemotherapy 医学-药学

CiteScore

3.70

自引率

0.00%

发文量

144

审稿时长

6-12 weeks

期刊介绍： The Journal of Chemotherapy is an international multidisciplinary journal committed to the rapid publication of high quality, peer-reviewed, original research on all aspects of antimicrobial and antitumor chemotherapy. The Journal publishes original experimental and clinical research articles, state-of-the-art reviews, brief communications and letters on all aspects of chemotherapy, providing coverage of the pathogenesis, diagnosis, treatment, and control of infection, as well as the use of anticancer and immunomodulating drugs. Specific areas of focus include, but are not limited to: · Antibacterial, antiviral, antifungal, antiparasitic, and antiprotozoal agents; · Anticancer classical and targeted chemotherapeutic agents, biological agents, hormonal drugs, immunomodulatory drugs, cell therapy and gene therapy; · Pharmacokinetic and pharmacodynamic properties of antimicrobial and anticancer agents; · The efficacy, safety and toxicology profiles of antimicrobial and anticancer drugs; · Drug interactions in single or combined applications; · Drug resistance to antimicrobial and anticancer drugs; · Research and development of novel antimicrobial and anticancer drugs, including preclinical, translational and clinical research; · Biomarkers of sensitivity and/or resistance for antimicrobial and anticancer drugs; · Pharmacogenetics and pharmacogenomics; · Precision medicine in infectious disease therapy and in cancer therapy; · Pharmacoeconomics of antimicrobial and anticancer therapies and the implications to patients, health services, and the pharmaceutical industry.