万古霉素药物浓度监测在治疗严重脓毒症中的临床应用

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Abstract Objective To access the therapeutic drug monitoring (TDM) of vancomycin in the treatment of severe sepsis. Methods Patients with sepsis admitted to ICU of People's Hospital of Inner Mongolia Autonomous Region from June 2018 to December 2021 were collected as research objects. They were divided into TDM group and non-TDM group according to whether or not TDM was applied. The white blood cell count, procalcitonin, C-reactive protein, neutrophil rate, serum creatinine, length of hospital stay and duration of vancomycin in the two groups after treatment were recorded to evaluate the clinical efficacy of the two groups. Results After treatment, there were no significant differences in WBC count, procalcitonin, C-reactive protein, neutrophil rate, hospital stay and vancomycin use time between the two groups. However, the mean values of serum creatinine (139.99±84.80) μmol/L, neutrophil rate (79.94±7.89) % and procalcitonin (3.72±5.73) ng/ml in TDM group were significantly lower than those in non-TDM group, with statistical significance (P<0.05). Conclusions TDM of vancomycin has a good guiding effect in the treatment of patients with severe sepsis, maintaining an effective drug concentration and reducing the risk of renal toxicity.

Key words： therapeutic drug monitoring vancomycin severe sepsis clinical effect

Received: 10 June 2023

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	WANG Xiaohong
	Siriguleng
	JIA Zhixin
	YIN Hongxia

Cite this article:

WANG Xiaohong,Siriguleng,JIA Zhixin等. Clinical application of TDM of vancomycin in treatment of severe sepsis[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(6): 516-519.

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https://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR https://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2024/V35/I6/516

[1]	Kumar A, Roberts D,Wood K E,et al.Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock[J]. Crit Care Med, 2006,34:1589-1596.
[2]	Moellering R C, Vancomycin: a 50-year reassessment[J]. Clin Infect Dis,2006, 42(1): S3-S4.
[3]	Koziol M M, Szczepanik A, Baranowicz I,et al. The investigation of staphylococcus aureus and coagulase-negative staphylococci nasal carriage among patients undergoing hemodialysis[J]. Microbiol Res,2006,161:281.
[4]	Ye Z K, Tang H L, Zhai S D. Benefits of therapeutic drug monitoring of vancomycin: a systematic review and meta-analysis[J]. PLoS One,2013, 8:e77169.
[5]	Kullar R, Davis S L, Levine D P, et al. Impact of vancomycin exposure on outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia: support for consensus guidelines suggested targets[J]. Clin Infect Dis,2011,52:975-981.
[6]	Sato S, Saito Y.Evaluation of the usefulness of vancomycin dosage design based on pharmacokinetics/ pharmacodynamics theory[J]. JPN J Chemother,2007,55:220-224.
[7]	Tijana K,Branislava M,Pedja K,et al.Population pharmacokinetic model of Vancomycin based on therapeutic drug monitoring data in critically ill septic patients[J]. J Crit Care,2020,55:116-121 .
[8]	梁宝方,苏建伟,沈利汉,等.ICU患者影响万古霉素血药浓度的相关因素分析[J].中国抗生素杂志, 2020, 45(8):819-824.
[9]	Bosso J A, Nappi J, Rudisill C, Wellein M, et al. Relationship between vancomycin trough concentrations and nephrotoxicity: a prospective multicenter trial[J].Antimicrob Agents Chemother,2011,55:5475-5479.
[10]	Iwamoto T, Kagawa Y, Kojima M.Clinical efficacy of therapeutic drug monitoring in patients receiving vancomycin[J]. Biol Pharm Bull,2003,26: 876-879.
[11]	Kalligeros M, Karageorgos S A, Shehadeh F, et al.The association of acute kidney injury with the concomitant use of vancomycin and piperacillin/tazobactam in children: a systematic review and meta-analysis[J]. Antimicrob Agents Chemother,2019, 63:e01572-19.
[12]	Singer M, Deutschman C S, Seymour C W, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) [J]. JAMA,2016,315(8):801-810.
[13]	Campassi M L,Gonzalez M C,Masevicius F D,et al. Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment [J].Rev Bras TerIntensiva,2014,26(1):13-20.
[14]	陈海琴,石庆平,孔令提,等.重症感染患者接受万古霉素治疗个体化药学服务临床价值评估——一项基于真实世界数据的回顾性病例对照试验[J].南方医科大学学报,2020,40(10):1380-1389.
[15]	Koch B P, Muller A E, Hunfeld N M, et al. Therapeutic drug monitoring of antibiotics in critically ill patients: current practice and future perspectives with a focus on clinical outcome[J]. Ther Drug Monit,2022,44(1):11-18.
[16]	李燕,王学彬,陈礼治,等.万古霉素血药浓度与临床疗效及急性肾损伤的关系[J].第二军医大学学报, 2021, 42(3):281-286.
[17]	刘桂芹,刘娜.某院万古霉素临床用药合理性分析[J].系统医学,2020,5(17):149-151.
[18]	姜惠婷.基于TDM的重症患者万古霉素个体化药学监护研究[D].延吉:延边大学,2023.
[19]	Miyai T, Imai S, Kashiwagi H, et al.A risk prediction flowchart of vancomycin-induced acute kidney injury to use when starting Vancomycin administration: a multicenter retrospective study.[J]. Antibiotics (Basel, Switzerland), 2020, 9(12): 121-126.
[20]	Jian Y, Lv H, Liu J, et al. Dynamic changes of staphylococcus aureus susceptibility to vancomycin, teicoplanin, and linezolid in a central teaching hospital in Shanghai China, 2008-2018[J]. Front Microbiol,2020,11:908.
[21]	He N, Su S, Yan Y, et al. The benefit of individualized vancomycin dosing via pharmacokinetic tools: a systematic review and meta-analysis[J]. Ann Pharmacother,2020, 54:331-343.
[22]	Monteiro J F, Hahn S R, Gonçalves J,et al.Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations[J].Pharmacol Res Perspect,2018,6(4):e00420.
[23]	Zhang Y, Wang T, Zhang D, et al. Therapeutic drug monitoring coupled with bayesian forecasting could prevent vancomycin-associated nephrotoxicity in renal insufficiency patients: a prospective study and pharmacoeconomic analysis[J].Ther Drug Monit,2020,42(4):600-609.
[24]	Bakke V, Sporsem H, Lippe E, et al. Vancomycin levels are frequently subtherapeutic in critically ill patients: a prospective observational study[J]. Acta Anaesthesiol Scand,2017,61(6):627-635.
[25]	张绵锋,李智业,吴苏武.万古霉素在脓毒症合并急性肾损伤患者中的应用[J].世界复合医学, 2022, 8(1):142-144.