Department of Pharmacy, Ningbo First Hospital, Ningbo, Zhejiang, P.R. China.
Br J Neurosurg. 2021 Apr;35(2):133-138. doi: 10.1080/02688697.2020.1769023. Epub 2020 May 27.
Therapeutic drug monitoring (TDM) aims to minimise the clinical impact of vancomycin (VCM) pharmacokinetic variability. However, TDM data are limited among specific patient populations, including postoperative neurosurgical populations. The objective of this study was to retrospectively investigate the influence of cerebrospinal fluid (CSF) drainage and other factors on the serum trough concentrations of VCM.
We analysed 154 patients who had been hospitalised in the neurosurgical ward and received intravenous infusions of VCM. We compared the daily doses of VCM, serum VCM concentrations, and serum concentration/dose ratio (C/D ratio) between patients who underwent CSF drainage (drainage group) and controls (nondrainage group). In addition, we also elucidated other factors affecting the attainment of target concentrations.
The patients in the drainage group showed a significantly lower trough concentration of VCM (6.2 ± 4.2 µg/mL) than that shown by the nondrainage group (8.5 ± 6.6 µg/mL, = 0.03). Furthermore, the patients in the drainage group showed a significantly different trough C/D ratio (3.1 ± 2.1) than that shown by the nondrainage group (4.3 ± 3.4, = 0.014). The Mann-Whitney test demonstrated significantly lower VCM trough levels with concomitant use of diuretic than without ( = 0.004). Multivariable logistic regression demonstrated that coadministered diuretic independently predicted subtherapeutic trough levels of <10 µg/mL ( = 0.04). The concomitant use of albumin and other variables exerted no effects on VCM trough levels.
These data suggest that CSF drainage and diuretics have different effects, but it seems that both lower the VCM concentration in postoperative neurosurgical patients. Our findings strongly suggest that a high dose of VCM is required to maintain optimal serum concentrations of VCM in patients managed with CSF drainage or concomitant use of diuretic.
治疗药物监测（TDM）旨在将万古霉素（VCM）药代动力学变异性对临床的影响降到最低。然而，在特定的患者人群中，包括术后神经外科患者人群，TDM 数据有限。本研究的目的是回顾性研究脑脊液（CSF）引流和其他因素对 VCM 血清谷浓度的影响。
我们分析了 154 名在神经外科病房住院并接受静脉注射 VCM 的患者。我们比较了接受 CSF 引流（引流组）和对照组（非引流组）患者的 VCM 日剂量、血清 VCM 浓度和血清浓度/剂量比（C/D 比）。此外，我们还阐明了其他影响目标浓度达到的因素。
引流组患者的 VCM 谷浓度（6.2±4.2μg/mL）明显低于非引流组（8.5±6.6μg/mL， =0.03）。此外，引流组患者的 VCM 谷 C/D 比（3.1±2.1）与非引流组（4.3±3.4， =0.014）明显不同。Mann-Whitney 检验显示，与未使用利尿剂相比，同时使用利尿剂时 VCM 谷水平显著降低（ =0.004）。多变量逻辑回归显示，同时使用利尿剂可独立预测谷水平低于 10μg/mL 的治疗效果不佳（ =0.04）。白蛋白和其他变量的同时使用对 VCM 谷水平没有影响。
这些数据表明，CSF 引流和利尿剂有不同的作用，但似乎两者都降低了术后神经外科患者的 VCM 浓度。我们的研究结果强烈表明，对于接受 CSF 引流或同时使用利尿剂的患者，需要高剂量的 VCM 来维持 VCM 的最佳血清浓度。
