Objective:To systematically evaluate the incidence and risk factors of acute kidney injury (AKI) induced by vancomycin in pediatric patients.Methods:Databases of PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang, VIP, Chinese Biomedical Database (CBM) were searched and articles about the risk factors of AKI induced by vancomycin in pediatric patients from inception to June 2024 were collected. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS) for the included studies. Meta-analysis of the data for relevant exposure factors extracted from the included literature was conducted using Rev Man 5.4. The strength of association between the exposure factors and AKI was expressed using the odds ratio ( OR) and its 95% confidence interval ( CI). Results:A total of 13 studies were entered, involving 11 073 patients. Of them, 1 388 patients were in AKI group and 9 685 patients in non-AKI group. The incidence of AKI was 12.53%, ranging from 4.62% to 27.07%. The quality evaluation results showed that the 13 documents were all of high-quality (NOS score ≥7 points). Meta-analysis showed that admission to intensive care unit (ICU) ( OR=2.39, 95% CI: 1.59-3.59, P<0.001), vancomycin using time ≥7 d ( OR=2.19, 95% CI: 1.44-3.34 P=0.003), vancomycin steady-state trough concentration ≥15 mg/L ( OR=2.98, 95% CI: 2.22-4.01, P<0.001), combined with nephrotoxic drugs ≥2 kinds ( OR=2.92, 95% CI=1.84-4.64, P<0.001), combined with piperacillin sodium and tazobactam sodium ( OR=2.71, 95% CI: 1.72- 4.27, P<0.001), combined with carbapenem ( OR=2.36, 95% CI: 1.36-4.10, P=0.002), combined with aminoglycosides ( OR=1.78, 95% CI: 1.35-2.35, P<0.001), combined with loop diuretics ( OR=3.16, 95% CI: 2.36- 4.23, P<0.001), combined with amphotericin B ( OR=2.26, 95% CI: 1.35-3.79, P=0.002), combined with contrast medium ( OR=2.34, 95% CI: 1.04-5.25, P=0.040), and combined with aciclovir ( OR=1.74, 95% CI: 1.04-2.84, P=0.030) were all risk factors of AKI induced by vancomycin in pediatric patients. Conclusions:The incidence of vancomycin-related AKI in pediatric patients was 12.53%. Admission to ICU, vancomycin trough concentration ≥15 mg/L, medication time ≥7 d, and concomitant use of ≥2 nephrotoxic drugs and etc.were risk factors of vancomycin-related AKI.

Objective:To systematically evaluate the incidence and risk factors of acute kidney injury (AKI) induced by vancomycin in pediatric patients.Methods:Databases of PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang, VIP, Chinese Biomedical Database (CBM) were searched and articles about the risk factors of AKI induced by vancomycin in pediatric patients from inception to June 2024 were collected. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS) for the included studies. Meta-analysis of the data for relevant exposure factors extracted from the included literature was conducted using Rev Man 5.4. The strength of association between the exposure factors and AKI was expressed using the odds ratio ( OR) and its 95% confidence interval ( CI). Results:A total of 13 studies were entered, involving 11 073 patients. Of them, 1 388 patients were in AKI group and 9 685 patients in non-AKI group. The incidence of AKI was 12.53%, ranging from 4.62% to 27.07%. The quality evaluation results showed that the 13 documents were all of high-quality (NOS score ≥7 points). Meta-analysis showed that admission to intensive care unit (ICU) ( OR=2.39, 95% CI: 1.59-3.59, P<0.001), vancomycin using time ≥7 d ( OR=2.19, 95% CI: 1.44-3.34 P=0.003), vancomycin steady-state trough concentration ≥15 mg/L ( OR=2.98, 95% CI: 2.22-4.01, P<0.001), combined with nephrotoxic drugs ≥2 kinds ( OR=2.92, 95% CI=1.84-4.64, P<0.001), combined with piperacillin sodium and tazobactam sodium ( OR=2.71, 95% CI: 1.72- 4.27, P<0.001), combined with carbapenem ( OR=2.36, 95% CI: 1.36-4.10, P=0.002), combined with aminoglycosides ( OR=1.78, 95% CI: 1.35-2.35, P<0.001), combined with loop diuretics ( OR=3.16, 95% CI: 2.36- 4.23, P<0.001), combined with amphotericin B ( OR=2.26, 95% CI: 1.35-3.79, P=0.002), combined with contrast medium ( OR=2.34, 95% CI: 1.04-5.25, P=0.040), and combined with aciclovir ( OR=1.74, 95% CI: 1.04-2.84, P=0.030) were all risk factors of AKI induced by vancomycin in pediatric patients. Conclusions:The incidence of vancomycin-related AKI in pediatric patients was 12.53%. Admission to ICU, vancomycin trough concentration ≥15 mg/L, medication time ≥7 d, and concomitant use of ≥2 nephrotoxic drugs and etc.were risk factors of vancomycin-related AKI.

OBJECTIVE To systematically evaluate the risk factors for cefoperazone/sulbactam-induced coagulation dysfunction in adult patients. METHODS Retrieved from CNKI， VIP， CBM， Wanfang data， PubMed， Embase and Cochrane Library， randomized controlled trial （RCT）， case-control study or cohort study about cefoperazone/sulbactam-induced coagulation dysfunction in adult patients were collected from the inception to Apr. 30th， 2023. After literature screening， data extraction and quality evaluation， meta-analysis was carried out by using RevMan 5.3 software. RESULTS A total of 13 studies were included， among which 11 studies were case-control studies， and 2 studies were cohort studies， involving 18 387 patients in total. Meta- analysis showed that the proportion of advanced age [OR＝2.04， 95%CI （1.14， 3.64）， P＝0.02]， liver insufficiency [OR＝5.95， 95%CI （4.21， 8.40）， P＜0.000 01]， renal insufficiency [OR＝3.51， 95%CI （3.04， 4.05）， P＜0.001]， hypoproteinemia [OR＝ 1.90， 95%CI（1.37， 2.62）， P＜0.001]， poor diet [OR＝7.25， 95%CI （5.13， 10.24）， P＜0.000 01]， daily dose of cefoperazone/ sulbactam ≥9 g [OR＝3.95， 95%CI （2.45，6.37）， P＜0.001]， medication duration of cefoperazone/sulbactam ≥10 d [OR＝2.43， 95%CI （1.81， 3.28）， P＜0.001]， combined use of anticoagulant drugs [OR＝2.84， 95%CI （2.03， 3.97）， P＜0.001]， combined with malignant tumor [OR＝1.60， 95%CI （1.20， 2.15），P＜0.001] in patients with abnormal coagulation function were significantly higher than those with normal coagulation function. CONCLUSIONS Advanced age， liver insufficiency， renal insufficiency， complicated with malignant tumors and hypoalbuminemia， combined use of anticoagulant drugs， poor diet， daily dose ≥9 g， and medication duration≥10 days are risk factors for coagulation dysfunction caused by cefoperazone/sulbactam.

Objective:To explored the clinical characteristics and risk factors of acute kidney injury (AKI) caused by vancomycin combined with piperacillin sodium and tazobactam sodium (VPT) in adult patients with severe infections.Methods:Clinical data of adult patients with VPT-related AKI (AKI group) hospitalized at the Affiliated Hospital of Gansu Medical College and People′s Hospital of Hengshui from January 2022 to August 2023 due to severe infections were collected. The occurrence time, severity, and prognosis of AKI in the AKI group were descriptive statistically analyzed. According to the ratio of 1∶1, patients in the control group were randomly selected from those who did not develop AKI after using VPT in the same period. The general information, disease status, baseline laboratory tests results, and the application of VPT and combined drugs, etc. in patients of the 2 groups were collected. The influencing factors of AKI caused by VPT were analyzed by univariate and multivariate logistic regression.Results:A total of 1 547 adult patients with severe infections were treated with VPT, of which 175 (11.3%) developed AKI. Among the 175 patients, 81 (46.3%) were male and 94 (53.7%) were female, with an age of (55±22) years; the time from VPT treatment to the occurrence of AKI was (4±1) days, and the severity of AKI was staged as grade 1, 2 and 3 in 97 (55.4%), 54 (30.9%), and 24 (13.7%) patients, respectively. After drug withdrawal, the renal function gradually recovered in 169 (96.6%) of the 175 patients with AKI, and 6 (3.4%) patients needed continuous renal replacement therapy. Multivariate logistic regression analysis showed that the trough concentration of vancomycin >20 mg/L [odds ratio ( OR)=2.105, 95% confidence interval ( CI): 1.427-3.105, P=0.022], the duration of vancomycin treatment ≥11 days ( OR=1.518, 95% CI: 1.232-1.871, P=0.014), the duration of piperacillin sodium and tazobactam sodium treatment ≥14 days ( OR=1.826, 95% CI: 1.152-2.894, P=0.029) and longer duration of combined vasoactive drugs ( OR=3.315, 95% CI: 1.428-7.695, P=0.005) were independent risk factors for VPT-related AKI. Conclusions:VPT-related AKI in adult patients with severe infections mostly occurs within one week of combination therapy, and the severity was mostly stage 1 and 2. The trough concentration of vancomycin >20 mg/L, longer course of VPT treatment, and longer time of combined vasoactive drugs can increase the risk of VPT-related AKI.

Objective:To explored the clinical characteristics and risk factors of acute kidney injury (AKI) caused by vancomycin combined with piperacillin sodium and tazobactam sodium (VPT) in adult patients with severe infections.Methods:Clinical data of adult patients with VPT-related AKI (AKI group) hospitalized at the Affiliated Hospital of Gansu Medical College and People′s Hospital of Hengshui from January 2022 to August 2023 due to severe infections were collected. The occurrence time, severity, and prognosis of AKI in the AKI group were descriptive statistically analyzed. According to the ratio of 1∶1, patients in the control group were randomly selected from those who did not develop AKI after using VPT in the same period. The general information, disease status, baseline laboratory tests results, and the application of VPT and combined drugs, etc. in patients of the 2 groups were collected. The influencing factors of AKI caused by VPT were analyzed by univariate and multivariate logistic regression.Results:A total of 1 547 adult patients with severe infections were treated with VPT, of which 175 (11.3%) developed AKI. Among the 175 patients, 81 (46.3%) were male and 94 (53.7%) were female, with an age of (55±22) years; the time from VPT treatment to the occurrence of AKI was (4±1) days, and the severity of AKI was staged as grade 1, 2 and 3 in 97 (55.4%), 54 (30.9%), and 24 (13.7%) patients, respectively. After drug withdrawal, the renal function gradually recovered in 169 (96.6%) of the 175 patients with AKI, and 6 (3.4%) patients needed continuous renal replacement therapy. Multivariate logistic regression analysis showed that the trough concentration of vancomycin >20 mg/L [odds ratio ( OR)=2.105, 95% confidence interval ( CI): 1.427-3.105, P=0.022], the duration of vancomycin treatment ≥11 days ( OR=1.518, 95% CI: 1.232-1.871, P=0.014), the duration of piperacillin sodium and tazobactam sodium treatment ≥14 days ( OR=1.826, 95% CI: 1.152-2.894, P=0.029) and longer duration of combined vasoactive drugs ( OR=3.315, 95% CI: 1.428-7.695, P=0.005) were independent risk factors for VPT-related AKI. Conclusions:VPT-related AKI in adult patients with severe infections mostly occurs within one week of combination therapy, and the severity was mostly stage 1 and 2. The trough concentration of vancomycin >20 mg/L, longer course of VPT treatment, and longer time of combined vasoactive drugs can increase the risk of VPT-related AKI.

OBJECTIVE:To systematically review the clinical efficacy and safety of macrolide antimicrobial drugs in the adju-vant treatment of lung infection of Pseudomonas aeruginosa (PA) and provide evidence-based reference for the clinical treatment. METHODS:Retrieved from PubMed,Ovid,CJFD,VIP,CBM and Wangfang database,randomized controlled trials(RCT)about sensitive antimicrobial drugs of PA combined with macrolide antimicrobial drugs (test group) vs. sensitive antimicrobial drugs of PA alone(control group)in the treatment of lung infection of PA were included and comprehensively evaluated using Jadad scale. The homogeneity results were analyzed by Rev Man 5.2 software. RESULTS:13 RCTs were included,involving 872 patients. Me-ta-analysis showed that the effective rate [OR=6.42,95%CI(4.23,9.74),P<0.001] and PA clearance rate[OR=6.10,95%CI(4.10, 9.09),P<0.001] in test group were significantly higher than control group;the time of body temperature returned to normal[MD=-1.14,95%CI(-1.35,-0.94),P<0.001],time of cough sputum disappearance [MD=-1.70,95%CI (-1.97,-1.44),P<0.001] and time of the blood returned to normal[MD=-1.24,95%CI(-2.04,-0.43),P<0.001] were significantly shorter than control group,there were significant difference between 2 groups. There was no significant difference in the incidence of adverse re-action [OR=1.30,95%CI(0.73,2.31),P=0.37]. CONCLUSIONS:Macrolide antimicrobial drugs have good efficacy and safety in the adjuvant treatment of PA infection. Duo to the limit of research methodology quality,it remains to be further verified by large-sample and high-quality RCT.