Wang J L, Wang H F, Shi M J, Xu J Y, Huang L L, Li Q, Liu S Q, Huang Y Z
Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China.
Zhonghua Nei Ke Za Zhi. 2019 Aug 1;58(8):572-576. doi: 10.3760/cma.j.issn.0578-1426.2019.08.005.
To assess the rate achieving the target vancomycin trough level (VTL) and its influencing factors in critically ill patients. The retrospective observational study recruited adult patients treated with intravenous vancomycin in the intensive care unit (ICU) at Zhongda Hospital from January 2015 to December 2017. Serum VTL was tested at steady state. Patients' demographics, the sites of infection, microbial culture results, the severity of illness, laboratory data and vancomycin regimen were obtained at the baseline. The rate achieving target VTL (15-20 mg/L) was analyzed based on renal function. Linear regression was performed to determine the influencing factors of VTL. A total of 85 patients were enrolled, among whom only 23.5% (20/85) achieved the target VTL. In patients with normal renal function, the achieving rate was only 11.4% (4/35), and 80.0% (28/35) was lower than the target trough level multiple linear regression analysis showed that procalcitonin (PCT), estimated glomerular filtration rate (eGFR) and acute physiology and chronic health disease classification system Ⅱ (APACHE Ⅱ) score were independent factors associated with VTL. Achieving target VTL in critically ill patients is not satisfactory. Further study to optimize the administration is needed to facilitate prompt attainment of target VTL.
评估重症患者达到万古霉素谷浓度(VTL)目标值的比例及其影响因素。这项回顾性观察性研究纳入了2015年1月至2017年12月在中大医院重症监护病房(ICU)接受静脉注射万古霉素治疗的成年患者。在稳态时检测血清VTL。在基线时获取患者的人口统计学资料、感染部位、微生物培养结果、疾病严重程度、实验室数据和万古霉素治疗方案。根据肾功能分析达到目标VTL(15 - 20mg/L)的比例。进行线性回归以确定VTL的影响因素。共纳入85例患者,其中仅23.5%(20/85)达到目标VTL。在肾功能正常的患者中,达标率仅为11.4%(4/35),80.0%(28/35)低于目标谷浓度。多元线性回归分析显示,降钙素原(PCT)、估计肾小球滤过率(eGFR)和急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分是与VTL相关的独立因素。重症患者达到目标VTL的情况并不理想。需要进一步研究优化给药方案,以促进尽快达到目标VTL。