高通量血液透析患者万古霉素给药方案的评估：一项观察性研究。

Soto Guerrero Yazmín, Hernández Castillo Ricardo, Santiago Edgardo, Ramírez Yuch Norman, Jaume Anselmi Francisco, Jové Rebeca, Flores Raúl, Lebrón Roberto, Ramírez Rivera José

Internal Medicine Department, Ponce School of Medicine and Health Consortium and Hospital de La Concepción, San Germán, Puerto Rico.

Bol Asoc Med P R. 2012 Jul-Sep;104(3):10-4.

UNLABELLED

Vancomycin is the mainstay antibiotic used in hemodialysis group due to high prevalence of methicillin resistant Staphylococcus Aureus. For years regimens of vancomycin in high flux hemodialysis (HFHD) patients were designed to achieve a pre-dialysis vancomycin concentration between 5-20 ug/mL. Recent guidelines increased the recommended pre-dialysis level to 15-20 ug/ml for health care associated infections, bacteremia and osteomyelitis. The purpose of this study was to determine if the loading dose (LD) before HFHD and the maintenance dose (MD) of vancomycin achieved a pre-dialysis concentration between 15-20 ug/ml on HFHD in-patients with a suspected infection. The second purpose was to predict an adequate vancomycin dosage to achieve the new recommended levels.

MATERIAL AND METHODS

An observational prospective study on hospitalized adult patients on HFHD with evidence of infection treated with 1 gm LD of vancomycin and 500 mg MD. Plasma levels of vancomycin were measured before each HFHD for three consecutive times. Age, gender, weight at admission, blood flow rate, dialyzer flow rate, type of filter and HFHD length were evaluated.

RESULTS

Twenty-one patients met the inclusion criteria. All of them were treated with 1 gm LD of vancomycin and 500 mg MD protocol. The mean pre-dialysis concentration #1 was 10.8 ug/mL. The mean pre-dialysis concentration #2 was 13 ug/mL, and the mean pre-dialysis concentration #3 was 12 ug/mL. Only 36% of HFHD sessions achieved an adequate vancomycin level. A liner regression analysis predicted that a loading dose of 23 mg/kg LD and 8 mg/kg MD achieved the recommended pre-dialysis vancomycin concentration.

CONCLUSIONS

Current dose regimen of 1 gm LD and 500 mg MD of Vancomycin are not adequate to achieve recommended pre-dialysis level of 15-20 ug/mL for health care associated infections, bacteremia and osteomyelitis in most patients on HFHD. Based on our statistical analysis, we recommended that 23 mg/kg of LD and 8 mg/kg of MD would achieve an adequate vancomycin level.

未标注

由于耐甲氧西林金黄色葡萄球菌的高流行率，万古霉素是血液透析组中使用的主要抗生素。多年来，高通量血液透析（HFHD）患者的万古霉素治疗方案旨在使透析前万古霉素浓度达到5-20微克/毫升。最近的指南将与医疗保健相关感染、菌血症和骨髓炎的推荐透析前水平提高到15-20微克/毫升。本研究的目的是确定在疑似感染的HFHD住院患者中，HFHD前的负荷剂量（LD）和万古霉素的维持剂量（MD）是否能使透析前浓度达到15-20微克/毫升。第二个目的是预测达到新推荐水平所需的足够万古霉素剂量。

材料与方法

对接受1克LD万古霉素和500毫克MD治疗且有感染证据的HFHD住院成年患者进行观察性前瞻性研究。连续三次在每次HFHD前测量万古霉素的血浆水平。评估年龄、性别、入院体重、血流速度、透析器流速、滤器类型和HFHD时长。

结果

21名患者符合纳入标准。他们均接受了1克LD万古霉素和500毫克MD方案治疗。第一次透析前平均浓度为10.8微克/毫升。第二次透析前平均浓度为13微克/毫升，第三次透析前平均浓度为12微克/毫升。只有36%的HFHD疗程达到了足够的万古霉素水平。线性回归分析预测，23毫克/千克的LD和8毫克/千克的MD负荷剂量可达到推荐的透析前万古霉素浓度。