Obara Vitor Yuzo, Zacas Carolina Petrus, Carrilho Claudia Maria Dantas de Maio, Delfino Vinicius Daher Alvares
Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Londrina - Londrina (PR), Brasil.
Universidade Estadual de Londrina - Londrina (PR), Brasil.
Rev Bras Ter Intensiva. 2016 Oct-Dec;28(4):380-386. doi: 10.5935/0103-507X.20160071.
: This study aimed to assess whether currently used dosages of vancomycin for treatment of serious gram-positive bacterial infections in intensive care unit patients provided initial therapeutic vancomycin trough levels and to examine possible factors associated with the presence of adequate initial vancomycin trough levels in these patients.
: A prospective descriptive study with convenience sampling was performed. Nursing note and medical record data were collected from September 2013 to July 2014 for patients who met inclusion criteria. Eighty-three patients were included. Initial vancomycin trough levels were obtained immediately before vancomycin fourth dose. Acute kidney injury was defined as an increase of at least 0.3mg/dL in serum creatinine within 48 hours.
: Considering vancomycin trough levels recommended for serious gram-positive infection treatment (15 - 20µg/mL), patients were categorized as presenting with low, adequate, and high vancomycin trough levels (35 [42.2%], 18 [21.7%], and 30 [36.1%] patients, respectively). Acute kidney injury patients had significantly greater vancomycin trough levels (p = 0.0055, with significance for a trend, p = 0.0023).
: Surprisingly, more than 40% of the patients did not reach an effective initial vancomycin trough level. Studies on pharmacokinetic and dosage regimens of vancomycin in intensive care unit patients are necessary to circumvent this high proportion of failures to obtain adequate initial vancomycin trough levels. Vancomycin use without trough serum level monitoring in critically ill patients should be discouraged.
本研究旨在评估目前用于治疗重症监护病房患者严重革兰氏阳性菌感染的万古霉素剂量是否能提供初始治疗性万古霉素谷浓度，并检查与这些患者初始万古霉素谷浓度充足相关的可能因素。
采用便利抽样进行前瞻性描述性研究。收集了2013年9月至2014年7月符合纳入标准患者的护理记录和病历数据。共纳入83例患者。在万古霉素第四次给药前立即测定初始万古霉素谷浓度。急性肾损伤定义为48小时内血清肌酐至少升高0.3mg/dL。
按照治疗严重革兰氏阳性感染推荐的万古霉素谷浓度（15 - 20µg/mL），患者被分为万古霉素谷浓度低、充足和高组（分别为35例[42.2%]、18例[21.7%]和,30例[36.1%]）。急性肾损伤患者的万古霉素谷浓度显著更高（p = 0.0055，趋势有显著性，p = 0.0023）。
令人惊讶的是，超过40%的患者未达到有效的初始万古霉素谷浓度。有必要对重症监护病房患者万古霉素的药代动力学和给药方案进行研究，以避免出现如此高比例的未能获得充足初始万古霉素谷浓度的情况。应避免在重症患者中使用万古霉素而不监测血清谷浓度。
