Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles-ULB, Route de Lennik 808, 1070 Brussels, Belgium.
Int J Antimicrob Agents. 2013 Mar;41(3):261-6. doi: 10.1016/j.ijantimicag.2012.10.018. Epub 2013 Jan 9.
Vancomycin is frequently administered as a continuous infusion to treat severe infections caused by Gram-positive bacteria. Previous studies have suggested a loading dose of 15 mg/kg followed by continuous infusion of 30 mg/kg in patients with normal renal function; however, there are no dosing recommendations in patients with renal failure undergoing continuous renal replacement therapy (CRRT). Data from all adult septic patients admitted to a Department of Intensive Care over a 3-year period in whom vancomycin was given as a continuous infusion were reviewed. Patients were included if they received vancomycin for ≥48h during CRRT. Vancomycin levels were obtained daily. During the study period, 85 patients (56 male; mean age 65±15 years; weight 85±24kg) met the inclusion criteria. Median (interquartile range) APACHE II and SOFA scores were 24 (20-29) and 11 (7-14), respectively, and the overall mortality rate was 59%. Mean vancomycin doses were 16.4±6.4 (loading dose), 23.5±8.1 (Day 1), 23.2±7.4 (Day 2) and 23.3±11.0 (Day 3) mg/kg, resulting in blood concentrations of 24.7±9.0 (Day 1), 26.0±8.1 (Day 2) and 27.7±9.3 (Day 3) μg/mL. On Day 1, 43 patients (51%) had adequate drug concentrations (20-30 μg/mL), 17 (20%) had levels >30 μg/mL and 25 (29%) had levels <20 μg/mL. Most patients with adequate drug concentrations received a daily dose of 16-35 mg/kg. The intensity of CRRT directly influenced vancomycin concentrations on Day 1 of therapy.
万古霉素常被用作连续输注，以治疗由革兰阳性菌引起的严重感染。先前的研究表明，肾功能正常的患者给予负荷剂量 15mg/kg 后，持续输注 30mg/kg；但在接受连续肾脏替代治疗（CRRT）的肾衰竭患者中，尚无剂量推荐。回顾了在 3 年内入住重症监护病房的所有成年败血症患者的数据，这些患者在接受 CRRT 的过程中接受了万古霉素的连续输注。如果患者在 CRRT 期间接受万古霉素治疗≥48 小时，则将其纳入研究。每天测定万古霉素水平。在研究期间，85 例患者（56 例男性；平均年龄 65±15 岁；体重 85±24kg）符合纳入标准。中位数（四分位距）APACHE II 和 SOFA 评分分别为 24（20-29）和 11（7-14），总体死亡率为 59%。万古霉素平均剂量为 16.4±6.4（负荷剂量）、23.5±8.1（第 1 天）、23.2±7.4（第 2 天）和 23.3±11.0（第 3 天）mg/kg，血药浓度分别为 24.7±9.0（第 1 天）、26.0±8.1（第 2 天）和 27.7±9.3（第 3 天）μg/mL。第 1 天，43 例（51%）患者药物浓度足够（20-30μg/mL），17 例（20%）患者药物浓度>30μg/mL，25 例（29%）患者药物浓度<20μg/mL。大多数药物浓度足够的患者接受了 16-35mg/kg/d 的日剂量。CRRT 的强度直接影响治疗第 1 天的万古霉素浓度。
