<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1699-714X</journal-id>
<journal-title><![CDATA[Revista de la OFIL ]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. OFIL·ILAPHAR]]></abbrev-journal-title>
<issn>1699-714X</issn>
<publisher>
<publisher-name><![CDATA[Organización de Farmacéuticos Ibero-Latinoamericanos]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1699-714X2021000100011</article-id>
<article-id pub-id-type="doi">10.4321/s1699-714x20210001000011</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Lesão renal aguda no tratamento concomitante de vancomicina com piperacilina/tazobactam]]></article-title>
<article-title xml:lang="en"><![CDATA[Acute kidney injury in the concomitant treatment of vancomycin with piperacillin/tazobactam]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Coutinho Cabral]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
<xref ref-type="aff" rid="Aa"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Sousa Martins  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="A1a">
<institution><![CDATA[,Unidade de Saúde Local da Guarda  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2021</year>
</pub-date>
<volume>31</volume>
<numero>1</numero>
<fpage>45</fpage>
<lpage>48</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S1699-714X2021000100011&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S1699-714X2021000100011&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S1699-714X2021000100011&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[RESUMO  Objectivos: Avaliar a incidência de lesão renal aguda em pacientes que recebem tratamento concomitante com vancomicina e piperacilina/tazobactam, em comparação com grupos de pacientes tratados com ambos os antibióticos isoladamente ou com vancomicina associada a meropenem.  Métodos: Foram definidos 4 grupos de estudo constituídos por pacientes submetidos aos seguintes regimes de antibioterapia nos últimos 2 anos: um grupo tratado concomitantemente com vancomicina e piperacilina/tazobactam; um grupo tratado apenas com piperacilina/tazobactam; um grupo de pacientes tratados apenas com vancomicina; um grupo tratado com a associação vancomicina e meropenem. Para cada paciente nos grupos de estudo, foram analisados os valores de creatinina sérica imediatamente antes do início de cada tratamento e após o término do mesmo. Foi elaborada uma base de dados na qual foram identificados os pacientes, idade, data de início e término do tratamento, valores iniciais e finais de creatinina sérica assim como respectivas diferenças. Os pacientes foram seleccionados de acordo com os seguintes critérios de elegibilidade: duração do tratamento superior a 72 horas e com valores disponíveis de creatinina sérica imediatamente antes e após o tratamento. Este estudo utiliza a classificação KDIGO, que define lesão renal aguda quando um dos seguintes critérios é encontrado:   - Aumento da creatinina sérica maior ou igual a 0,3 mg/dL em 48 horas;  - Aumento da creatinina sérica maior ou igual a 1,5x o valor de referência, que se sabe ou presume-se que tenha ocorrido dentro de uma semana;  - Débito urinário inferior a 0,5 ml/kg/h por mais de 6 horas consecutivas.  Resultados: Os resultados obtidos para as amostras analisadas indicam que 30,8% dos pacientes tratados com a combinação vancomicina+piperacilina/tazobactam desenvolveram lesão renal aguda; a amostra com tratamento único com piperacilina/tazobactam apresentou 12% de casos; os grupos tratados com vancomicina isoladamente e com vancomicina associada a meropenem revelaram uma incidência de 7,1%.  Discussão/conclusões: Os resultados obtidos confirmam que há um aumento da incidência de lesão renal aguda em pacientes submetidos ao tratamento concomitante com vancomicina e piperacilina/tazobactam, comparativamente a pacientes tratados com vancomicina ou piperacilina/tazobactam isoladamente ou até com a associação vancomicina+meropenem. Embora a associação entre lesão renal aguda e o tratamento concomitante com vancomicina e piperacilina/tazobactam seja conhecida e alvo de estudos recentes em vários países, ainda não foi desenvolvido um trabalho de pesquisa nesta área em Portugal, apesar de se tratar de uma opção terapêutica muitas vezes considerada nos hospitais nacionais. Perante uma situação de antibioterapia empírica, sempre que possível, a combinação de vancomicina+piperacilina/tazobactam deve ser evitada e substituída por outras alternativas mais seguras, particularmente em pacientes com insuficiência renal ou tratados concomitantemente com fármacos potencialmente nefrotóxicos.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[SUMMARY  Objectives: Evaluate the incidence of acute renal injury in patients receiving concomitant treatment with vancomycin and piperacillin/tazobactam, compared to groups of patients treated with both antibiotics alone or with vancomycin associated to meropenem.  Methods: Were defined 4 study groups consisting of patients submitted to the following antibiotic treatment regimens in the last 2 years: one group concomitantly treated with vancomycin and piperacillin/tazobactam; a group treated only with piperacillin/tazobactam; a group of patients treated with vancomycin alone; a group treated with vancomycin and meropenem in combination. For each patient in the study groups, serum creatinine values were analyzed immediately prior to the start of each treatment and after the end of treatment. A database was elaborated in which patient identification, age, start and end date of treatment, initial and final serum creatinine values as respective diferences, were established. Patients were selected according to the following eligibility criteria: treatment duration greater than 72 hours and with available serum creatinine values immediately before and after treatment. This study uses the KDIGO classification, which defines acute kidney injury when one of the following criteria is found:   - Increased serum creatinine greater than or equal to 0.3 mg/dL within 48 hours;  - Increased serum creatinine greater than or equal to 1.5x the reference value, which is known or presumed to have occurred within one week;  - Urine output less than 0.5 ml/kg/hr for more than 6 consecutive hours.  Findings: The results obtained for the analyzed samples indicate that 30.8% of the patients treated with the combination vancomycin+piperacillin/tazobactam developed acute renal injury, whereas the sample with a single treatment with piperacillin/tazobactam presented 12% of cases and the vancomycin groups alone and vancomycin plus meropenem showed both an incidence of 7.1%.  Discussion/conclusions: The results obtained, confirm the tendency to increase the incidence of acute renal injury in patients submitted to concomitant treatment with vancomycin and piperacillin/ tazobactam compared to patients treated with vancomycin or piperacillin/tazobactam alone, or with the association vancomycin+meropenem. Although the association between acute renal injury and concomitant treatment with vancomycin and piperacillin/tazobactam is known and has been the target of several recent studies in some countries, a research work in this field has not yet been developed in Portugal, especially when it is a therapeutic option often considered in national hospitals. In the context of empiric antibiotic therapy, whenever possible, the combination of vancomycin+piperacillin/tazobactam should be avoided and replaced by other safer alternatives, particularly in patients with impaired renal function or treated concomitantly with potentially nephrotoxic drugs.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Vancomicina]]></kwd>
<kwd lng="pt"><![CDATA[piperacilina/tazobactam]]></kwd>
<kwd lng="pt"><![CDATA[meropenem]]></kwd>
<kwd lng="pt"><![CDATA[lesão renal aguda]]></kwd>
<kwd lng="pt"><![CDATA[creatinina]]></kwd>
<kwd lng="en"><![CDATA[Vancomycin]]></kwd>
<kwd lng="en"><![CDATA[piperacillin/tazobactam]]></kwd>
<kwd lng="en"><![CDATA[meropenem]]></kwd>
<kwd lng="en"><![CDATA[acute renal injury]]></kwd>
<kwd lng="en"><![CDATA[creatinine]]></kwd>
</kwd-group>
</article-meta>
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