重症监护中伏立康唑的治疗药物监测实践
Voriconazole Therapeutic Drug Monitoring Practices in Intensive Care.
作者信息
van Wanrooy Marjolijn J P, Rodgers Michael G G, Span Lambert F R, Zijlstra Jan G, Uges Donald R A, Kosterink Jos G W, van der Werf Tjip S, Alffenaar Jan-Willem C
机构信息
*University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, †University of Groningen, University Medical Center Groningen, Department of Critical Care, and ‡University of Groningen, University Medical Center Groningen, Department of Hematology; §University of Groningen, University Medical Center Groningen, Division of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy; and ¶University of Groningen, University Medical Center Groningen, Departments of Internal Medicine and Pulmonary Diseases and Tuberculosis, the Netherlands.
出版信息
Ther Drug Monit. 2016 Jun;38(3):313-8. doi: 10.1097/FTD.0000000000000284.
BACKGROUND
Routine therapeutic drug monitoring of voriconazole seems to be beneficial. This study investigated the therapeutic drug monitoring practices in intensive care to derive possible recommendations for improvement.
METHODS
A retrospective chart review was performed for patients aged ≥18 years who started treatment with voriconazole, which lasted for at least 3 days while being admitted to an intensive care unit to assess possible differences between the patients with and without voriconazole trough concentrations measured.
RESULTS
In 64 (76%) of the 84 patients, voriconazole trough concentrations were measured. The groups differed significantly with respect to the duration of voriconazole treatment and intensive care unit admission. Time of sampling was very early and therefore inappropriate for 49% of the first measured voriconazole trough concentrations and in 48% of the subsequent measured concentrations. Of the 349 trough concentrations measured, 129 (37%) were outside the therapeutic window. In 11% of these cases, no recommendation was provided without identifiable reason. In addition, 27% of recommended dose adjustments were not implemented, probably because the advice was not suited for the specific clinical situation.
CONCLUSIONS
The performance of voriconazole therapeutic drug monitoring can still be improved although voriconazole concentrations were monitored in most patients. A multidisciplinary approach-for instance by means of antifungal stewardship-will probably be able to overcome problems encountered such as timing of sampling, incompleteness of data in clinical context, and lack of implementation of recommendations.
背景
伏立康唑的常规治疗药物监测似乎有益。本研究调查了重症监护中的治疗药物监测实践，以得出可能的改进建议。
方法
对年龄≥18岁且开始接受伏立康唑治疗至少3天的重症监护病房患者进行回顾性病历审查，以评估测量了和未测量伏立康唑谷浓度的患者之间的可能差异。
结果
84例患者中有64例（76%）测量了伏立康唑谷浓度。两组在伏立康唑治疗持续时间和重症监护病房住院时间方面存在显著差异。采样时间非常早，因此49%的首次测量的伏立康唑谷浓度以及48%的后续测量浓度不合适。在测量的349个谷浓度中，129个（37%）超出治疗窗。在这些病例中，11%没有明确原因就未给出建议。此外，27%的推荐剂量调整未实施，可能是因为建议不适合具体临床情况。
结论
尽管大多数患者监测了伏立康唑浓度，但伏立康唑治疗药物监测的表现仍可改进。多学科方法——例如通过抗真菌管理——可能能够克服遇到的问题，如采样时间、临床背景下数据不完整以及建议未实施等问题。
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