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目的:探讨万古霉素联合哌拉西林钠他唑巴坦钠（VPT）致重症感染成年患者急性肾损伤（AKI）的临床特征及危险因素。方法:收集甘肃医学院附属医院和河北省衡水市人民医院2022年1月至2023年8月重症感染成年住院患者中的VPT相关AKI患者的临床资料（AKI组），对AKI的发生时间、严重程度分期和预后等进行描述性统计分析。从同期使用VPT未发生AKI的患者中按照与AKI组1∶1的比例以随机数字法抽取对照组患者。收集2组患者的一般资料、疾病状况、基线实验室检查结果、VPT用药情况、并用药物等信息，对VPT致AKI发生的影响因素进行单因素分析和多因素logistic回归分析。结果:共有1 547例重症感染成年患者使用了VPT治疗，其中175例（11.3%）患者发生AKI。175例AKI患者中男性81例（46.3%），女性94例（53.7%）；年龄（55±22）岁；从VPT治疗至AKI发生的时间为（4±1）d，AKI分期为1、2和3期者分别为97例（55.4%）、54例（30.9%）和24例（13.7%）。175例患者中169例（96.6%）在停药后肾功能逐渐恢复，6例（3.4 %）需要持续肾脏替代治疗。多因素logistic回归分析结果显示，万古霉素血浆谷浓度>20 mg/L[比值比（ OR）=2.105，95%置信区间（ CI）：1.427~3.105， P=0.022]、万古霉素疗程≥11 d（ OR=1.518，95% CI：1.232~1.871， P=0.014）、哌拉西林钠他唑巴坦钠疗程≥14 d（ OR=1.826，95% CI：1.152~2.894， P=0.029）和并用血管活性药物时间较长（ OR=3.315，95% CI：1.428~7.695， P=0.005）是VPT相关AKI发生的独立危险因素。 结论:严重感染的成年患者VPT相关AKI多发生于联合治疗的1周内，严重程度多为1期和2期。万古霉素血浆谷浓度>20 mg/L、较长的VPT疗程及并用血管活性药物时间较长可增加VPT相关AKI的发生风险。

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.