高齢者におけるバンコマイシンとタゾバクタム/ピペラシリン併用投与による 腎障害の発症率・臨床的特徴・腎予後に関する検討.

Combined administration of tazobactam-piperacillin (T/P) is a risk factor for the development of vancomycin (VCM)-induced nephrotoxicity (VIN). We herein investigated the incidence, clinical characteristics, and prognosis of VIN in elderly patients treated with VCM and T/P. Patients admitted to the Tokyo Metropolitan Institute for Geriatrics and Gerontology who were administered VCM and T/P were included in this study. Patient backgrounds, serum VCM concentrations, and VCM and T/P dosage were also investigated. The patients were divided into VIN and non-VIN groups and compared. In the VIN group, time to onset of VIN and time to recovery of renal function were investigated. Of 53 patients, 10 (18.9%) developed VIN. Median time to VIN onset was 9.0 (1-24) days. Eight (80%) of the ten patients in the VIN group recovered their renal function. Serum VCM concentrations in the VIN group varied from 5.0 to 20.1 µg/mL; some patients developed VIN even when their serum VCM concentrations were low. This study suggests that the incidence of VCM and T/P-induced nephrotoxicity in elderly patients is not higher than that previously reported in a study that included younger patients. Additionally, when VCM is administered in combination with T/P, VIN may occur even at low serum VCM concentrations, and reduced renal function estimated based on serum creatinine concentration may not be associated with the development of VIN, Furthermore, the combination of VCM and T/P may not specifically worsen the renal prognosis in elderly patients with VIN. [ABSTRACT FROM AUTHOR]