泌尿系统肾功能不全患者中耐甲氧西林金黄色葡萄球菌感染的万古霉素最佳剂量

Optimal vancomycin doses for methicillin-resistant Staphylococcus aureus infection in urological renal dysfunction patients.

作者信息

Shigemura Katsumi, Osawa Kayo, Yamamichi Fukashi, Tanaka Kazushi, Tokimatsu Issei, Arakawa Soichi, Fujisawa Masato

机构信息

Division of Urology, Department of Organ Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan,

出版信息

Int Urol Nephrol. 2015 Jun;47(6):887-91. doi: 10.1007/s11255-015-0973-5. Epub 2015 Apr 22.

DOI:10.1007/s11255-015-0973-5

PMID:25899764

Abstract

PURPOSE

To investigate the optimal dose of vancomycin (VCM) for methicillin-resistant Staphylococcus aureus infections in the urological patients including renal dysfunction.

METHODS

We had 143 sets of available data from the consecutive patients treated in the urological department for analysis in VCM dose, VCM trough and estimated glomerular filtration rate: eGFR at VCM trough examination. Patients were classified according to eGFR level, and we calculated the regression line between VCM dose and VCM trough accordingly.

RESULTS

Median VCM dose were 1000 (range 500-3500) mg per day, the VCM trough was 15.6 ± 7.89 μg/ml, and eGFR was 61.1 ± 27.2 ml/min/1.73 m(2). Our regression analysis (x axis: VCM dose (mg) and y axis: VCM trough (μg/ml) was statistically significant in the group with eGFR of 30-60 ml/min/1.73 m(2) (y = 26.103x + 481.7; r (2) = 0.1291) and the group with eGFR of 60-90 ml/min/1.73 m(2) (y = 48.891x + 350.75; r (2) = 0.2561) in both with (p = 0.021 and 0.035, respectively) or without (p = 0.012 and 0.004, respectively) adjustments by body weight for VCM doses.

CONCLUSION

These data showed that the optimal dose of VCM varied according to the eGFR value in consecutive urological patients with various renal functions.

摘要

目的

探讨万古霉素（VCM）用于治疗包括肾功能不全在内的泌尿外科耐甲氧西林金黄色葡萄球菌感染患者的最佳剂量。

方法

我们收集了泌尿外科连续治疗患者的143组可用数据，用于分析万古霉素剂量、谷浓度以及估算肾小球滤过率：万古霉素谷浓度检查时的估算肾小球滤过率（eGFR）。根据eGFR水平对患者进行分类，并据此计算万古霉素剂量与谷浓度之间的回归线。

结果

万古霉素的每日中位剂量为1000（范围500 - 3500）mg，谷浓度为15.6±7.89μg/ml，eGFR为61.1±27.2 ml/min/1.73 m²。我们的回归分析（x轴：万古霉素剂量（mg），y轴：万古霉素谷浓度（μg/ml））在eGFR为30 - 60 ml/min/1.73 m²的组（y = 26.103x + 481.7；r² = 0.1291）和eGFR为60 - 90 ml/min/1.73 m²的组（y = 48.891x + 350.75；r² = 0.2561）中均具有统计学意义，无论万古霉素剂量是否根据体重进行调整（分别为p = 0.021和0.035，以及p = 0.012和0.004）。