Tang Wen, Cho Yeoungjee, Hawley Carmel M, Badve Sunil V, Johnson David W
Division of Nephrology,1 Peking University Third Hospital, Beijing, China;
Perit Dial Int. 2014 Mar-Apr;34(2):219-26. doi: 10.3747/pdi.2012.00318. Epub 2014 Jan 2.
There is limited available evidence regarding the role of monitoring serum gentamicin concentrations in peritoneal dialysis (PD) patients receiving this antimicrobial agent in gram-negative PD-associated peritonitis.
Using data collected in all patients receiving PD at a single center who experienced a gram-negative peritonitis episode between 1 January 2005 and 31 December 2011, we investigated the relationship between measured serum gentamicin levels on day 2 following initial empiric antibiotic therapy and subsequent clinical outcomes of confirmed gram-negative peritonitis.
Serum gentamicin levels were performed on day 2 in 51 (77%) of 66 first gram-negative peritonitis episodes. Average serum gentamicin levels on day 2 were 1.83 ± 0.84 mg/L with levels exceeding 2 mg/L in 22 (43%) cases. The overall cure rate was 64%. No cases of ototoxicity were observed. Day-2 gentamicin levels were not significantly different between patients who did and did not have a complication or cure. Using multivariable logistic regression analysis, failure to cure peritonitis was not associated with either day-2 gentamicin level (adjusted odds ratio (OR) 0.96, 95% confidence interval (CI) 0.25 - 3.73) or continuation of gentamicin therapy beyond day 2 (OR 0.28, 0.02 - 3.56). The only exception was polymicrobial peritonitis, where day-2 gentamicin levels were significantly higher in episodes that were cured (2.06 ± 0.41 vs 1.29 ± 0.71, p = 0.01). In 17 (26%) patients receiving extended gentamicin therapy, day-5 gentamicin levels were not significantly related to peritonitis cure.
Day-2 gentamicin levels did not predict gentamicin-related harm or efficacy during short-course gentamicin therapy for gram-negative PD-related peritonitis, except in cases of polymicrobial peritonitis, where higher levels were associated with cure.
关于在接受抗微生物药物治疗革兰氏阴性腹膜透析（PD）相关腹膜炎的PD患者中监测血清庆大霉素浓度的作用，现有证据有限。
利用在单一中心接受PD治疗且在2005年1月1日至2011年12月31日期间发生革兰氏阴性腹膜炎发作的所有患者收集的数据，我们调查了初始经验性抗生素治疗后第2天测得的血清庆大霉素水平与确诊的革兰氏阴性腹膜炎后续临床结局之间的关系。
66例首次革兰氏阴性腹膜炎发作中的51例（77%）在第2天进行了血清庆大霉素水平检测。第2天的平均血清庆大霉素水平为1.83±0.84mg/L，22例（43%）病例的水平超过2mg/L。总体治愈率为64%。未观察到耳毒性病例。有并发症或治愈的患者与未发生并发症或治愈的患者之间第2天的庆大霉素水平无显著差异。使用多变量逻辑回归分析，腹膜炎未治愈与第2天的庆大霉素水平（调整后的优势比（OR）0.96，95%置信区间（CI）0.25 - 3.73）或庆大霉素治疗持续超过第2天（OR 0.28，0.02 - 3.56）均无关。唯一的例外是混合性腹膜炎，治愈发作的第2天庆大霉素水平显著更高（2.06±0.41对1.29±0.71，p = 0.01）。在17例（26%）接受延长庆大霉素治疗的患者中，第5天的庆大霉素水平与腹膜炎治愈无显著相关性。
在针对革兰氏阴性PD相关腹膜炎的短程庆大霉素治疗期间，第2天的庆大霉素水平不能预测庆大霉素相关的损害或疗效，但混合性腹膜炎病例除外，其中较高水平与治愈相关。
