Nephrotoxicity of continuous amphotericin B in critically ill patients with abdominal sepsis: a retrospective analysis with propensity score matching.

Autor:	Geersing TH; Department of Clinical Pharmacy, OLVG, Amsterdam, The Netherlands., Franssen EJF; Department of Clinical Pharmacy, OLVG, Amsterdam, The Netherlands., Spronk PE; Department of Intensive Care Medicine, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands., van Kan HJM; Department of Clinical Pharmacy, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands., den Reijer M; Department of Clinical Microbiology & Infection Prevention, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands., van der Voort PHJ; Department of Critical Care, University Medical Center Groningen, University of Groningen, The Netherlands.; TIAS School for Business and Society, Tilburg University, Tilburg, The Netherlands.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2021 Dec 24; Vol. 77 (1), pp. 246-252.
DOI:	10.1093/jac/dkab372
Abstrakt:	Background: Continuous infusion of conventional amphotericin B (CCAB) is used in ICUs for pre-emptive treatment of invasive fungal infections. Amphotericin B has previously been associated with nephrotoxicity. Objectives: To investigate if CCAB with therapeutic drug monitoring (TDM) results in renal impairment over time in critically ill patients with abdominal sepsis. Patients and Methods: The study was conducted at mixed medical-surgical ICUs of two large teaching hospitals in the Netherlands. Consecutive patients who were treated on the ICUs between 2006 and 2019 for abdominal sepsis, with or without CCAB, were included. CCAB dosing was guided by TDM. Serum creatinine concentrations and renal failure scores of patients with CCAB treatment were compared with those without CCAB treatment. Excluded were: (i) patients treated with CCAB for less than 72 h; and (ii) patients with renal replacement therapy. Results: A total of 319 patients were included (185 treated with CCAB and 134 controls). A multiple linear regression model showed that the serum creatinine concentration was independent of CCAB treatment (β = -0.023; 95% CI = -12.2 to 7.2; P = 0.615). Propensity score matching resulted in 134 pairs of CCAB-treated and non-treated patients. Again, the analysis of these pairs showed that the cumulative CCAB dose was not associated with serum creatinine concentration during intensive care treatment (β = 0.299; 95% CI = -0.38 to 0.98; P = 0.388). Conclusions: CCAB with TDM did not result in renal impairment over time in critically ill patients with abdominal sepsis. (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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