Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Ann Pharmacother. 2011 Oct;45(10):1193-8. doi: 10.1177/106002801104501001. Epub 2011 Sep 6.
Optimization of the timing of appropriate antibiotics is crucial to improve the management of patients in severe sepsis and septic shock. Vancomycin is commonly used empirically in cases of nosocomial infections in critically ill patients. Therefore, early optimization of vancomycin pharmacokinetics is likely to improve outcomes.
To evaluate a pharmacokinetic program to predict serum vancomycin concentrations in accordance with administered dose, weight, height, and creatinine clearance in a critically ill population.
We conducted a prospective observational single-center study in a 45-bed intensive care unit (ICU). All patients hospitalized in the ICU requiring intravenous treatment with vancomycin for a suspected infection were enrolled. The modalities of vancomycin therapy and the monitoring of serum concentrations were left to the discretion of the treating clinician. We compared the measured serum vancomycin concentrations with those predicted by the MM-USCPACK program and analyzed the factors influencing the prediction.
Fifty-four intravenous vancomycin courses were administered in 48 critically ill patients over the 3-month study. The precision was considered acceptable, based on a relative precision equal to 8.9% (interquartile range 3.5-18.9%) and the relative bias for all predictions was equal to -1.3%. Overall, 77.3% of predictions were within 20% of observed concentrations; factors correlating with a poorer prediction were a change in renal function, obesity, and the magnitude of organ dysfunction on initiation of vancomycin (expressed by a Systemic Organ Failure Assessment score >11).
The MM-USCPACK program is a useful and reliable tool for prediction of serum vancomycin concentrations in patients hospitalized in ICU and likely reflects the close monitoring of renal function in this setting. For some patients (more severely ill, obese, or significant change in renal function during vancomycin therapy), predictions were less precise.
优化适当抗生素的时机对于改善严重脓毒症和脓毒性休克患者的治疗至关重要。万古霉素常用于治疗重症监护病房（ICU）中危重病患者的医院获得性感染。因此，早期优化万古霉素的药代动力学可能会改善预后。
评估一种药代动力学方案，以根据给药剂量、体重、身高和肌酐清除率预测 ICU 中危重病患者的万古霉素血清浓度。
我们进行了一项前瞻性观察性单中心研究，纳入了在 45 张床位的 ICU 住院、因疑似感染而需要静脉注射万古霉素治疗的所有患者。万古霉素治疗方案和血清浓度监测由治疗医生决定。我们将测量的血清万古霉素浓度与 MM-USCPACK 程序预测的浓度进行比较，并分析影响预测的因素。
在 3 个月的研究期间，对 48 例危重病患者的 54 个静脉万古霉素疗程进行了评估。基于相对精度为 8.9%（四分位间距为 3.5-18.9%）的可接受精度和所有预测的相对偏差为-1.3%，预测结果被认为是可接受的。总体而言，77.3%的预测值在观察浓度的 20%以内；与预测值较差相关的因素包括肾功能变化、肥胖以及万古霉素起始时器官功能障碍的严重程度（通过全身性器官功能衰竭评估评分>11 表示）。
MM-USCPACK 程序是一种用于预测 ICU 住院患者血清万古霉素浓度的有用且可靠的工具，可能反映了在此环境中对肾功能的密切监测。对于某些患者（病情更严重、肥胖或万古霉素治疗期间肾功能变化较大），预测结果的精度较低。
