Acute kidney injury (AKI) is a commonly reported adverse effect of administration of antimicrobials. While AKI can be associated with poorer outcomes, there is little information available to understand rates of AKI in children exposed to various antimicrobials. We performed a structured review using the PubMed and Embase databases. Articles were included if they provided an AKI definition in patients who were < 19 years of age receiving an antimicrobial and reported the frequency of AKI. Author-defined AKI rates were calculated for each study and mean pooled estimates for each antimicrobial were derived from among all study participants. Pooled estimates were also derived for those studies that reported AKI according to pRIFLE (pediatric risk, injury, failure, loss, end stage criteria), AKIN (acute kidney injury network), or KDIGO (kidney disease improving global outcomes) creatinine criteria. A total of 122 studies evaluating 28 antimicrobials met the inclusion criteria. Vancomycin was the most commonly studied drug: 11,514 courses across 44 included studies. Among the 27,285 antimicrobial exposures, the overall AKI rate was 13.2% (range 0–42.1% by drug), but the rate of AKI varied widely across studies (range 0–68.8%). Cidofovir (42.1%) and conventional amphotericin B (37.0%) had the highest pooled rates of author-defined AKI. Eighty-one studies used pRIFLE, AKIN, or KDIGO AKI criteria and the pooled rates of AKI were similar to author-defined AKI rates. In conclusion, antimicrobial-associated AKI is reported to occur frequently in children, but the rates of AKI varies widely across studies and drugs. Most published studies examined hospitalized patients and heterogeneity in study populations and in author definitions of AKI are barriers to a comparison of nephrotoxicity risk among antimicrobials in children.

急性肾损伤（AKI）是一种常见的抗菌药物不良反应。虽然 AKI 可能与较差的预后相关，但几乎没有可用信息来了解接触各种抗菌药物的儿童中 AKI 的发生率。我们使用 PubMed 和 Embase 数据库进行了结构化审查。如果文章提供了 19 岁以下接受抗菌药物治疗的患者的 AKI 定义并报告了 AKI 频率，则文章将被纳入。计算每项研究作者定义的 AKI 率，并从所有研究参与者中得出每种抗菌药物的平均汇总估计值。还根据 pRIFLE（儿科风险、损伤、失败、损失、终末期标准）、AKIN（急性肾损伤网络）或 KDIGO（改善总体预后的肾脏疾病）肌酐标准报告 AKI 的研究得出了汇总估计值。共有 122 项研究评估了 28 种抗菌药物符合纳入标准。万古霉素是最常研究的药物：44 项纳入研究中的 11,514 个课程。在 27,285 例抗菌药物暴露中，总体 AKI 率为 13.2%（按药物范围为 0-42.1%），但不同研究中 AKI 发生率差异很大（范围为 0-68.8%）。西多福韦 (42.1%) 和传统两性霉素 B (37.0%) 的作者定义的 AKI 合并发生率最高。81 项研究使用 pRIFLE、AKIN 或 KDIGO AKI 标准，汇总的 AKI 发生率与作者定义的 AKI 发生率相似。总之，据报道，与抗菌药物相关的 AKI 在儿童中经常发生，但不同研究和药物的 AKI 发生率差异很大。大多数已发表的研究都检查了住院患者，研究人群中的异质性以及 AKI 的作者定义是儿童抗菌药物肾毒性风险比较的障碍。