Kachroo Sumesh, Dao Thanh, Zabaneh Firas, Reiter Margaret, Larocco Mark T, Gentry Layne O, Garey Kevin W
Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, TX 77030, USA.
Ann Pharmacother. 2006 Mar;40(3):381-5. doi: 10.1345/aph.1G565. Epub 2006 Feb 14.
In 2001, vancomycin replaced cefuroxime for antibiotic prophylaxis in patients undergoing cardiac surgery at our institution due to high rates of surgical site infections caused by methicillin-resistant Staphylococcus spp. However, few data supported the use of vancomycin for surgical prophylaxis.
To determine the tolerance of vancomycin for antibiotic prophylaxis and incidence of vancomycin-resistant Enterococcus (VRE) in cardiac surgery patients.
In 2 separate studies, we assessed the adverse effects in patients given perioperative vancomycin (study 1) and the incidence of VRE in patients given perioperative vancomycin (study 2). Study 1 was a prospective cohort study of patients undergoing coronary artery bypass graft (CABG) or valve replacement surgery given vancomycin (1 dose preoperatively/2 doses postoperatively) for antibiotic prophylaxis between October 2003 and December 2004. Patients were assessed for tolerance to the antibiotic regimen. In study 2, cardiac surgery patients receiving perioperative vancomycin were screened for VRE before therapy and at day 7 of hospitalization. VRE was detected using standard microbiologic procedures.
In study 1, 1161 patients (CABG = 75%; valve = 19%; both = 6%) were evaluated. All patients but one (99.9%) were prescribed preoperative vancomycin. Therapy was changed for 34 (2.9%) patients, of which 20 changes were due to physician preference for another antibiotic. The only toxicity that required a change in the vancomycin regimen was red man's syndrome, which was experienced by 9 (0.8%) patients. Four patients did not receive a second postoperative dose due to prior renal insufficiency. Patients were most commonly switched to cefuroxime (n = 26), linezolid (n = 2), cefepime (n = 2), gatifloxacin, cefazolin, levofloxacin, or ceftriaxone (n = 1, each). In study 2, 100 patients were screened for the emergence of VRE colonization. No patient was VRE positive at baseline and 4 (4%) were positive at day 7.
Surgical antibiotic prophylaxis with vancomycin was reasonably well tolerated in CABG and valve replacement surgery, with a 4% incidence of VRE colonization.
2001年，由于耐甲氧西林葡萄球菌属导致手术部位感染率较高，我院心脏手术患者的抗生素预防用药由头孢呋辛改为万古霉素。然而，支持使用万古霉素进行手术预防的资料很少。
确定心脏手术患者使用万古霉素进行抗生素预防的耐受性以及耐万古霉素肠球菌（VRE）的发生率。
在两项独立研究中，我们评估了围手术期使用万古霉素患者的不良反应（研究1）以及围手术期使用万古霉素患者的VRE发生率（研究2）。研究1是一项前瞻性队列研究，研究对象为2003年10月至2004年12月期间接受冠状动脉旁路移植术（CABG）或瓣膜置换手术并使用万古霉素（术前1剂/术后2剂）进行抗生素预防的患者。评估患者对该抗生素方案的耐受性。在研究2中，对接受围手术期万古霉素治疗的心脏手术患者在治疗前和住院第7天进行VRE筛查。使用标准微生物学程序检测VRE。
在研究1中，共评估了1161例患者（CABG占75%；瓣膜手术占19%；两者均做占6%）。除1例患者外，所有患者（99.9%）均接受了术前万古霉素治疗。34例（2.9%）患者的治疗方案发生了改变，其中20例改变是由于医生更倾向于使用另一种抗生素。唯一需要改变万古霉素治疗方案的毒性反应是红人综合征，9例（0.8%）患者出现了该症状。4例患者由于既往肾功能不全未接受术后第二剂药物治疗。患者最常换用的药物是头孢呋辛（n = 26）、利奈唑胺（n = 2）、头孢吡肟（n = 2）、加替沙星、头孢唑林、左氧氟沙星或头孢曲松（各n = 1）。在研究2中，对100例患者进行了VRE定植情况筛查。基线时无患者VRE阳性，第7天有4例（4%）阳性。
在CABG和瓣膜置换手术中，使用万古霉素进行手术抗生素预防的耐受性较好，VRE定植发生率为4%。
