血清万古霉素谷浓度升高与肥胖的关联。
The association of elevated trough serum vancomycin concentrations with obesity.
作者信息
Richardson Janice, Scheetz Marc, O'Donnell E Paul
机构信息
Captain James A. Lovell Federal Health Care Center, 3001 Green Bay Rd, North Chicago, IL 60064, USA; Mercy Hospital & Medical Center, 2525 S. Michigan Avenue, Chicago, IL 60616, USA.
Midwestern University, Chicago College of Pharmacy, 555 31st St, Downers Grove, IL 60515, USA; Northwestern Memorial Hospital, Department of Pharmacy, 251 E. Huron St., Chicago, IL 60611, USA.
出版信息
J Infect Chemother. 2015 Jul;21(7):507-11. doi: 10.1016/j.jiac.2015.03.007. Epub 2015 Mar 20.
BACKGROUND
Obese patients display differences in vancomycin drug disposition, which may complicate attainment of appropriate serum vancomycin concentrations (SVCs). This study was conducted to determine if obesity leads to trough SVCs above the therapeutic range.
METHODS
This retrospective cohort study sought to determine the rate and predictors of high (i.e. >20 mg/L) serum trough levels according to level of obesity.
RESULTS
Increasing BMI predicted SVCs > 20 mg/L after controlling for dose, age, and serum creatinine. Obese patients had significantly higher mean trough SVCs compared to non-obese patients (16.5 mg/L vs 12.1 mg/L, p = 0.004) and a significantly higher proportion of obese patients had trough SVCs > 20 mg/L (18.9% vs 4.2%, p = 0.03).
CONCLUSION
Increasing obesity predicted higher probabilities of SVCs > 20 mg/L. Development of alternative dosing and management strategies for vancomycin may be necessary to account for pharmacokinetic changes associated with obesity.
背景
肥胖患者在万古霉素药物处置方面存在差异，这可能使达到适当的血清万古霉素浓度（SVC）变得复杂。本研究旨在确定肥胖是否会导致谷浓度SVC高于治疗范围。
方法
这项回顾性队列研究试图根据肥胖程度确定高（即>20mg/L）血清谷浓度的发生率和预测因素。
结果
在控制剂量、年龄和血清肌酐后，体重指数增加可预测SVC>20mg/L。与非肥胖患者相比，肥胖患者的平均谷浓度SVC显著更高（16.5mg/L对12.1mg/L，p=0.004），且肥胖患者中谷浓度SVC>20mg/L的比例显著更高（18.9%对4.2%，p=0.03）。
结论
肥胖程度增加预示SVC>20mg/L的可能性更高。可能需要制定万古霉素的替代给药和管理策略，以考虑与肥胖相关的药代动力学变化。
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