Mariani-Kurkdjian P, Nebbad H, Aujard Y, Bingen E
Service de microbiologie, hôpital Robert-Debré, AH-HP, 48, boulevard Sérurier, 75935 Paris cedex 19, France.
Arch Pediatr. 2008 Nov;15(11):1625-9. doi: 10.1016/j.arcped.2008.08.016. Epub 2008 Oct 9.
Vancomycin is the cornerstone of therapy against methicillin-resistant Staphylococcus in both community- and hospital-acquired infections. Monitoring vancomycin concentration is essential to prevent over- or underdosing of pediatric patients. However, only initial trough vancomycin concentrations may be needed to optimize dosages. The optimal rate of the trough serum level to the minimal inhibitory concentration (MIC) should be equal to or greater than 8 in severe infections.
The aim of this study was to analyze the initial trough serum levels of vancomycin obtained from pediatric patients treated with vancomycin for suspected or confirmed Staphylococcus infections in combination with MIC determination.
We reviewed the medical records of 3759 children aged, more than 1 month, and 358 neonate patients during a period of 10 years in Robert-Debré Hospital, Paris.
Serum levels were determined using the polarization fluorescence method. MIC was determined using the E-test method.
Of the 3759 children studied, 55% had a through serum level less than 10mg/L and 24% had greater than 15 mg/L. Of the 358 neonates, 43% had a trough serum level less than 10mg/L and 31% greater than 15 mg/L. Among these children, 425 had documented Staphylococcus bacteremia with vancomycin MIC determination. Determining the trough level concentration in infected pediatric patients remains mandatory to optimize the vancomycin regimen. The rate of the trough serum level to MIC was less than 4 in 50% of the patients and more than 10 in 5% of the patients.
万古霉素是治疗社区获得性和医院获得性耐甲氧西林金黄色葡萄球菌感染的基石。监测万古霉素浓度对于防止儿科患者用药过量或不足至关重要。然而，优化剂量可能仅需监测初始谷浓度。在严重感染中，谷血清水平与最低抑菌浓度（MIC）的最佳比率应等于或大于8。
本研究旨在分析因疑似或确诊金黄色葡萄球菌感染接受万古霉素治疗的儿科患者的初始谷血清水平，并结合MIC测定。
我们回顾了巴黎罗伯特-德布雷医院10年间3759名年龄超过1个月的儿童和358名新生儿患者的病历。
采用偏振荧光法测定血清水平。采用E-test法测定MIC。
在3759名研究儿童中，55%的谷血清水平低于10mg/L，24%的谷血清水平高于15mg/L。在358名新生儿中，43%的谷血清水平低于10mg/L，31%的谷血清水平高于15mg/L。在这些儿童中，425名记录有金黄色葡萄球菌菌血症并进行了万古霉素MIC测定。确定感染儿科患者的谷水平浓度对于优化万古霉素治疗方案仍然至关重要。50%的患者谷血清水平与MIC的比率低于4，5%的患者高于10。
