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基于预测准确性验证更换万古霉素治疗药物监测分析软件的有效性

[Validating the Effectiveness of Switching the Vancomycin TDM Analysis Software Based on the Predictive Accuracy].

作者信息

Imai Shungo, Yamada Takehiro, Ishiguro Nobuhisa, Miyamoto Takenori, Kagami Keisuke, Tomiyama Naoki, Niinuma Yusuke, Nagasaki Daisuke, Suzuki Koji, Yamagami Akira, Kasashi Kumiko, Kobayashi Masaki, Iseki Ken

机构信息

Department of Pharmacy, Hokkaido University Hospital.

Division of Infection Control and Prevention, Hokkaido University Hospital.

出版信息

Yakugaku Zasshi. 2017;137(9):1185-1192. doi: 10.1248/yakushi.17-00080.

Abstract

Based on the predictive performance in our previous study, we switched the therapeutic drug monitoring (TDM) analysis software for dose setting of vancomycin (VCM) from "Vancomycin MEEK TDM analysis software Ver2.0" (MEEK) to "SHIONOGI-VCM-TDM ver.2009" (VCM-TDM) in January 2015. In the present study, our aim was to validate the effectiveness of the changing VCM TDM analysis software in initial dose setting of VCM. The enrolled patients were divided into two groups, each having 162 patients in total, who received VCM with the initial dose set using MEEK (MEEK group) or VCM-TDM (VCM-TDM group). We compared the rates of attaining the therapeutic range (trough value; 10-20 μg/mL) of serum VCM concentration between the groups. Multivariate logistic regression analysis was performed to confirm that changing the VCM TDM analysis software was an independent factor related to attaining the therapeutic range. Switching the VCM TDM analysis software from MEEK to VCM-TDM improved the rate of attaining the therapeutic range by 21.6% (MEEK group: 42.6% vs. VCM-TDM group: 64.2%, p<0.01). Patient age ≥65 years, concomitant medication (furosemide) and the TDM analysis software used VCM-TDM were considered to be independent factors for attaining the therapeutic range. These results demonstrated the effectiveness of switching the VCM TDM analysis software from MEEK to VCM-TDM for initial dose setting of VCM.

摘要

基于我们之前研究中的预测性能,我们于2015年1月将用于万古霉素(VCM)剂量设定的治疗药物监测(TDM)分析软件从“万古霉素MEEK TDM分析软件Ver2.0”(MEEK)更换为“盐野义-VCM-TDM ver.2009”(VCM-TDM)。在本研究中,我们的目的是验证更换VCM TDM分析软件在VCM初始剂量设定中的有效性。纳入的患者被分为两组,每组各有162例患者,分别接受使用MEEK设定初始剂量的VCM(MEEK组)或VCM-TDM(VCM-TDM组)。我们比较了两组之间血清VCM浓度达到治疗范围(谷值;10 - 20μg/mL)的比率。进行多因素逻辑回归分析以确认更换VCM TDM分析软件是与达到治疗范围相关的独立因素。将VCM TDM分析软件从MEEK更换为VCM-TDM使达到治疗范围的比率提高了21.6%(MEEK组:42.6% vs. VCM-TDM组:64.2%,p<0.01)。患者年龄≥65岁、合并用药(呋塞米)以及使用VCM-TDM的TDM分析软件被认为是达到治疗范围的独立因素。这些结果证明了将VCM TDM分析软件从MEEK更换为VCM-TDM用于VCM初始剂量设定的有效性。

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