Spadaro Savino, Berselli Angela, Fogagnolo Alberto, Capuzzo Maurizia, Ragazzi Riccardo, Marangoni Elisabetta, Bertacchini Sara, Volta Carlo Alberto
Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy.
BMC Anesthesiol. 2015 Jun 27;15:95. doi: 10.1186/s12871-015-0065-1.
Administration of vancomycin in critically ill patients needs close regulation. While subtherapeutical vancomycin serum concentration (VSC) is associated with increased mortality, accumulation is responsible for nephrotoxicity. Our study aimed to estimate the efficacy of a vancomycin-dosing protocol in reaching appropriate serum concentration in patients with and without kidney dysfunction.
This was a retrospective study in critically ill patients treated with continuous infusion of vancomycin. Patients with creatinine clearance > 50 ml/min (Group A) were compared to those with creatinine clearance ≤ 50 ml/min (Group B).
348 patients were enrolled (210 in Group A, 138 in Group B). At first determination, patients with kidney dysfunction (Group B) had a statistically higher percentage of vancomycin in target range, while the percentage of patients with a VSC under the range was almost equal. These percentages differed at the subsequent measurements. The number of patients with low vancomycin concentration progressively decreased, except in those with augmented renal clearance; the percentage of patients with VSC over 30 mg/L was about 28 %, irrespective of the presence or absence of kidney dysfunction. Patients who reached a subtherapeutic level at the first VSC measurement had a significant correlation with in-hospital mortality.
Our protocol seems to allow a rapid achievement of a target VSC particularly in patients with kidney dysfunction. In order to avoid subtherapeutical VSC, our algorithm should be implemented by the estimation of the presence of an augmented renal clearance.
在重症患者中使用万古霉素需要密切监测。当万古霉素血清浓度（VSC）低于治疗水平时与死亡率增加相关，而药物蓄积则会导致肾毒性。我们的研究旨在评估万古霉素给药方案在肾功能正常和肾功能不全患者中达到合适血清浓度的效果。
这是一项针对接受万古霉素持续输注治疗的重症患者的回顾性研究。将肌酐清除率>50 ml/min的患者（A组）与肌酐清除率≤50 ml/min的患者（B组）进行比较。
共纳入348例患者（A组210例，B组138例）。首次测定时，肾功能不全患者（B组）万古霉素处于目标范围内的比例在统计学上更高，而VSC低于该范围的患者比例几乎相等。在随后的测量中，这些比例有所不同。万古霉素浓度低的患者数量逐渐减少，但肾脏清除率增加的患者除外；VSC超过30 mg/L的患者比例约为28%，无论是否存在肾功能不全。首次VSC测量时达到低于治疗水平的患者与院内死亡率显著相关。
我们的方案似乎能使患者迅速达到目标VSC，尤其是肾功能不全的患者。为避免VSC低于治疗水平，我们的算法应通过评估是否存在肾脏清除率增加来实施。
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