|
|
|
| Analysis of related factors of Vancomycin concentration not up to standard in ICU |
| YIN Yanyan1 ZHU Jing2 JIANG Li3▲ |
1.Urinary and Metabolic Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing 100144, China;
2.Department of Pneumology, Fu Xing Hospital, Capital Medical University, Beijing 100038, China;
3.Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing 100038, China |
|
|
|
Abstract Objective To investigate the influencing factors of Vancomycin concentration not up to standard, optimize clinical use. Methods From January 2016 to December 2017, in Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, the patients who received monitoring of Vancomycin blood concentration, and got creatinine clearance rate examination, hemodynamic monitoring at same time were retrospectivlye analyzed, the patients with drug dose up to standard were selected, according to Vancomycin concentration wheather up to standard or not, they were divided into two groups, blood concentration 10-20 μg/mL was as up to standard group, blood concentration 0～<10 μg/mL as not up to standard group. The basic information, plasma albumin, alanine aminotransferase, creatinine clearance rate (CCr), body mass index (BMI), and liquid balance during using Vancomycin were collected, single factor analysis and Logistic regression analysis were used to find out the factors influencing the serum concentration of Vancomycin. Results There were 55 patients with drug dose up to standard and whole clinical data, 28 cases were in blood concentration up to standard group, 27 cases were in blood concentration not up to standard group, BMI, CCr, CO, liquid balance in two groups were compared, the differences were statistically significant (P < 0.05), Logistic regression analysis result showed that CO, liquid balance during using Vancomycin were influence factors of blood concentration not blood concentration of patients in ICU (P < 0.05). Conclusion The level of CO, liquid balance during using Vancomycin are the factors influencing the serum concentration of vancomyc influence factors of blood concentration not blood concentration of patients in ICU.
|
|
|
|
|
|
[1] 万古霉素临床应用剂量专家组.万古霉素临床应用剂量中国专家共识[J].中华传染病杂志，2012，30（11）：641-646.
[2] Leu WJ，Liu YC，Wang HW，et al. Evaluation of a vancomycin dosing nomogram in achieving high target trough concentrations in Taiwanese patients [J]. Inter Infection Disease，2012，16（11）：e804-e810.
[3] Kullar R，Davis SL，Levine DP，et al. Impact of vancomycin exposure on outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia：support for consensus guidelines suggested targets [J]. CID，2011，52（15）：975-981.
[4] Zelenitsky S，Rubinstein E，Ariano R，et al. Vancomycin pharmacodynamics and survival in patients with methicillin-resistant Staphylococcus aureus-associated septic shock [J]. Inter J Antimicrobial Agents，2013，41（3）：255-260.
[5] Brown J，Brown K，Forrest A. Vancomycin AUC24/ MIC ratio in patients with complicated bacteremia and infective endocarditis due to methicillin -resistant Staphylococcus aureus and its association with attributable mortality during hospitalization [J]. Antimicrobial Agents and Chemotherapy，2012，56（2）：634-638.
[6] Liu C，Bayer A，Cosgrove SE，et al. Clinical practice guidelines by the Infectious diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children [J]. Clin Infect Dis，2011， 52（3）：e18.
[7] 万古霉素临床应用中国专家共识（2011版）[J].中国新药与临床，2011，30（8）：564.
[8] 朱卫江，姜文燕，蒋玉凤.ICU患者万古霉素血药浓度监测与个体化给药方案调整[J].中国药师，2017，20（8）：1437-1439.
[9] 蒙龙，方云，丁选胜.低谷浓度和高谷浓度万古霉素疗效与安全性比较[J].药学与临床研究，2013，21（1）：74-77.
[10] 陈春辉，李光辉，译.美国感染病学会治疗成人及儿童甲氧西林耐药金黄色葡萄球菌感染临床实践指南[J].中国感染与化疗杂志，2011，11（6）：428-435.
[11] Rybak M，Lomaestro B，Rotschafer JC，et al. Therapeutic monitoring of vancomycin in adult patients：a consensus review of the American Society of Health-System Pharmacists，the Infectious Diseases Society of America，and the Society of Infectious Diseases Pharmacists [J]. Clin Biochem Rev，2010，31（1），21-24.
[12] 邱志宏，高占红，王绍志，等.心肾功能对万古霉素的清除率影响分析[J].中国医院药学杂志，2015，35（9）：825-829.
[13] 梁培，郭晓芳.高肌酐清除率重症患者万古霉素血药浓度监测分析[J].药学与临床研究，2017，25（6）：493-496.
[14] álvarez R，López Cortés LE，Molina J. Vancomycin：Optimizing its clinical use [J]. Antimicrobial Agents Chemotherapy，2016，60（5）：1-37.
[15] Parrillo JE. Pathogenetic mechanisms of septic shock [J]. N Engl J Med，1993，328（20）：1471-1477.
[16] Pea F，Porreca L，Baraldo M，et al. High vancomycin dosage regimens required by intensive care unit patients cotreated with drugs to improve haemodynamics following cardiac surgical procedures [J]. J Antimicrob Chemother，2000，45（3）：329-35.
[17] Di Giantomasso D，Bellomo R，May CN. The haemodynamic and metabolic effects of epinephrine in experimental hyperdynamic septic shock [J]. Intensive Care Med，2005， 31（3）：454-462.
[18] Di Giantomasso D，May CN，Bellomo R. Norepinephrine and vital organ blood flow [J]. Intensive Care Med，2002， 28（12）：1804-1809.
[19] 申庆荣，李刚，卢秋玉，等.万古霉素血药浓度的影响因素分析 [J].中国抗生素杂志，2017，42（5）：429-434.
[20] 李志勇，漆松涛，方陆雄，等.不同给药途径万古霉素在脑脊液和血液中 药物浓度及疗效比较[J].中国神经精神疾病杂志，2007，33（10）：601-604. |
|
|
|
