The Nebraska Medical Center, Department of Pharmaceutical and Nutrition Care, 984031 Omaha, NE 68918-4031, USA.
Expert Opin Drug Saf. 2010 Jan;9(1):9-14. doi: 10.1517/14740330903413514.
Higher vancomycin concentrations are thought necessary for treatment of deep-seated methicillin-resistant Staphylococcus aureus (MRSA) infection, yet this may result in greater risk of nephrotoxicity. We evaluated the relationship of serum vancomycin trough concentration with clinical outcomes and nephrotoxicity for patients with deep-seated MRSA infection.
A retrospective cohort study evaluated adults with MRSA pneumonia, endocarditis or osteomyelitis who received vancomycin for > or = 5 days from June 2005 to June 2007. Patients were stratified by mean vancomycin trough level [low (< 15 mg/l), high (> or = 15 mg/l)]. Outcomes were clinical response, mortality, length of stay (LOS) and nephrotoxicity. Three definitions of nephrotoxicity were used: i) rise in serum creatinine (SCr) > or = 0.5 mg/dl; ii) 50% increase in SCr; and iii) 25% decrease in estimated creatinine clearance.
Fifty-five patients experiencing MRSA pneumonia (n = 28), endocarditis (n = 9), osteomyelitis (n = 20) and multiple infections (n = 2) were stratified into low (n = 39) and high (n = 16) groups. High group patients were more likely to be septic (p = 0.01) and have a higher APACHE II score (p = 0.01). After adjustment for APACHE II score, clinical response rates among survivors did not differ significantly. Risk of death was not significantly different between the high (19%) and low (5%) group patients (p = 0.1). LOS did not differ significantly between groups (p = 0.7). Nephrotoxicity occurred in the low and high groups, respectively, for 10 and 31% (p = 0.04) with definition 1, 10 and 31% (p = 0.04) with definition 2, and 13 and 25% (p = 0.1) with definition 3. After adjustment for APACHE II score, odds of nephrotoxicity based on definitions 1 or 2 were increased among the high versus low groups (OR = 3.27, 95% CI: 0.7 - 15.25, p = 0.1), although not statistically significant.
Clinical outcomes did not differ significantly between high and low trough groups for deep-seated MRSA infections. Nephrotoxicity was consistently higher in the high trough group, regardless of the definition used.
人们认为，治疗深部耐甲氧西林金黄色葡萄球菌（MRSA）感染需要更高的万古霉素浓度，但这可能会增加肾毒性的风险。我们评估了血清万古霉素谷浓度与深部 MRSA 感染患者的临床结局和肾毒性之间的关系。
回顾性队列研究评估了 2005 年 6 月至 2007 年 6 月期间接受万古霉素治疗> 5 天的 MRSA 肺炎、心内膜炎或骨髓炎的成年患者。根据万古霉素谷浓度均值将患者分层[低（< 15mg/l）；高（≥ 15mg/l）]。结局为临床反应、死亡率、住院时间（LOS）和肾毒性。使用三种肾毒性定义：i）血清肌酐（SCr）升高≥ 0.5mg/dl；ii）SCr 增加 50%；iii）估计肌酐清除率降低 25%。
55 例 MRSA 肺炎（n = 28）、心内膜炎（n = 9）、骨髓炎（n = 20）和多种感染（n = 2）患者分为低（n = 39）和高（n = 16）组。高组患者更容易发生败血症（p = 0.01）和 APACHE II 评分更高（p = 0.01）。调整 APACHE II 评分后，幸存者的临床反应率无显著差异。高组（19%）和低组（5%）患者的死亡率无显著差异（p = 0.1）。两组 LOS 无显著差异（p = 0.7）。低组和高组分别有 10%和 31%（p = 0.04）发生肾毒性，采用定义 1；分别有 10%和 31%（p = 0.04）发生肾毒性，采用定义 2；分别有 13%和 25%（p = 0.1）发生肾毒性，采用定义 3。调整 APACHE II 评分后，高组与低组相比，基于定义 1 或 2 的肾毒性的比值比（OR）增加（3.27，95%CI：0.7-15.25，p = 0.1），但无统计学意义。
深部 MRSA 感染患者的高、低谷组之间的临床结局无显著差异。无论使用哪种定义，高谷组的肾毒性始终较高。
