Department of Pharmacy, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213000, China.
Department of Gastroenterology, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213000, China.
BMC Infect Dis. 2020 May 13;20(1):341. doi: 10.1186/s12879-020-05067-7.
The aim of this study was to evaluate the influence of patient body mass index (BMI) and estimated creatinine clearance (CrCl) on serum vancomycin concentrations to define a possible optimal dosage regimen in overweight patients based on data obtained during therapeutic drug monitoring.
This retrospective study used data collected from January 2017 to January 2019. Adult patients (n = 204) received vancomycin treatment at a dose of 1000 mg every 12 h and underwent serum monitoring. Data collected included patient disease category, sex, age, height, weight, vancomycin concentrations, and serum creatinine. The CrCl values were estimated using the Cockcroft-Gault formula. In this study, statistical comparisons were performed on the results of patients according to serum vancomycin concentration.
Serum vancomycin concentration was significantly related to BMI (P < 0.001) and CrCl (P < 0.05) in adult patients. Furthermore, the trough serum vancomycin concentration showed a logarithmic correlation with BMI (R = - 0.5108, 95% CI: - 0.6082 to - 0.3982, P < 0.001) and CrCl (R = - 0.5739, 95% CI: - 0.6616 to - 0.4707, P < 0.001). The multivariate analysis showed that BMI and CrCl are independent contributors to the trough vancomycin concentration. Moreover, some of the patients with higher BMI (≥ 24 kg/m) met the goal trough concentration after an adjustment from 1000 mg every 12 h to 1000 mg every 8 h.
Serum vancomycin concentration decreases progressively with increasing BMI and the augmentation in CrCl in adult patients. The trough concentration of vancomycin should be continuously monitored for patients with a BMI ≥ 24 kg/m, and the dosage regimen should be adjusted to reach the target trough concentration in these patients to reduce the impact of BMI.
本研究旨在评估患者体重指数（BMI）和估计的肌酐清除率（CrCl）对血清万古霉素浓度的影响，以便根据治疗药物监测期间获得的数据，为超重患者确定可能的最佳剂量方案。
这是一项回顾性研究，使用了 2017 年 1 月至 2019 年 1 月期间收集的数据。接受 1000mg 每 12 小时 1 次剂量万古霉素治疗的成年患者（n=204）进行了血清监测。收集的数据包括患者疾病类别、性别、年龄、身高、体重、万古霉素浓度和血清肌酐。CrCl 值采用 Cockcroft-Gault 公式估算。在本研究中，根据血清万古霉素浓度对患者的结果进行了统计学比较。
成年患者的血清万古霉素浓度与 BMI（P<0.001）和 CrCl（P<0.05）显著相关。此外，谷值血清万古霉素浓度与 BMI（R=-0.5108，95%置信区间：-0.6082 至-0.3982，P<0.001）和 CrCl（R=-0.5739，95%置信区间：-0.6616 至-0.4707，P<0.001）呈对数相关。多变量分析表明，BMI 和 CrCl 是谷值万古霉素浓度的独立贡献者。此外，一些 BMI 较高（≥24kg/m）的患者在将剂量从 1000mg 每 12 小时调整为 1000mg 每 8 小时后达到了目标谷值浓度。
成年患者的血清万古霉素浓度随 BMI 的增加和 CrCl 的增加而逐渐降低。对于 BMI≥24kg/m 的患者，应持续监测万古霉素的谷浓度，并调整剂量方案以达到这些患者的目标谷浓度，以降低 BMI 的影响。
