RESUMO
Background: Trimethoprim/sulfamethoxazole (TMP/SMZ) is widely used in various clinical settings. Studies have revealed that it may cause acute kidney injury (AKI) in adults. However, the correlation between the use of TMP/SMZ and renal injury in pediatric patients is still unclear. This study aimed to identify the impact of TMP/SMZ on the occurrence of AKI in children. Methods: A retrospective observational study was conducted using data of patients treated with TMP/SMZ from the Paediatric Intensive Care clinical database. A newly developed criterion was used for the diagnosis of AKI, and univariate and multiple logistic regression analyses were performed to identify the risk factors of TMP/SMZ-related renal injury. Results: A total of 113 patients were included. The prevalence of AKI was 21.2% (24/113). Univariate analysis indicated that the AKI group showed significantly higher baseline serum creatinine level (46.00 vs. 37.00 µmol/L; P=0.034) and in-hospital mortality rate [29.2% (7/24) vs. 9.0% (8/89); P=0.01] than that of the non-AKI group. Multivariate analysis revealed that the occurrence of AKI was significantly associated with increased baseline serum creatinine level [odds ratio (OR) =1.029; 95% CI: 1.006-1.053; P=0.014] and concurrent use of vancomycin (OR =5.349; 95% CI: 1.381-20.714; P=0.015). A proportion of 79.2% of patients (19/24) developed AKI within the first 10 days of TMP/SMZ use. Conclusions: Elevated baseline serum creatinine level (≥40.25 µmol/L) and concurrent use of vancomycin were associated with the development of AKI in young patients. Further large multi-center prospective studies are necessary to confirm these relationships and validate their clinical significance.
RESUMO
Objective Class 1 integrase(intI 1),qacE△1-sul1 and sul2 genes were detected in trimethoprim-sulfamethoxazole resistant Stenotrophomonas maltophilia by PCR to assess the relationship between the antibiotic resistance mechanism for trimethoprim-sulfamethoxazole (TMP-SMZ)and these genes distribution.Methods S.maltophilia isolates were collected from patients treated in Affilitated hospital of Nanjing University of TCM during January to May in 2013,DNA was ab-stracted by boiling method and genes were detected by polymerase chain reaction.Results intI 1 genes were observed posi-tive in 25 of 28 strains resistant for TMP-SMZ,qacE△1-sul1 genes were positive in 21 while sul2 genes positive in 15,the positive rates of intI 1,qacE△1-sul1 and sul2 genes were 89.29%,75% and 53.57%;in 18 trimethoprim-sulfamethoxazole sensitive strains,5 were intI 1 positive,4 were qacE△1-sul1 positive while sul2 were none,the positive rates of intI1 and qacE△1-sul1 were 27.78% and 22.22%.Conclusion Most of stenotrophomonas maltophilia resisted trimethoprim-sulfa-methoxazole had intI 1,qacEΔ1-sul 1 and sul2 genes.
