Internal Medicine, Botucatu School of Medicine-UNESP, São Paulo State University Julio de Mesquita Filho, Distrito de Rubiao Junior, Botucatu P.O. 18618687, Sao Paulo, Brazil.
Int J Environ Res Public Health. 2020 Sep 19;17(18):6861. doi: 10.3390/ijerph17186861.
This study aimed to evaluate the reduction in vancomycin through intermittent haemodialysis (IHD) and prolonged haemodialysis (PHD) in acute kidney injury (AKI) patients with sepsis and to identify the variables associated with subtherapeutic concentrations. A prospective study was performed in patients admitted at an intensive care unit (ICU) of a Brazilian hospital. Blood samples were collected at the start of dialytic therapy, after 2 and 4 h of treatment and at the end of therapy to determine the serum concentration of vancomycin and thus perform pharmacokinetic evaluation and PK/PD modelling. Twenty-seven patients treated with IHD, 17 treated with PHD for 6 h and 11 treated with PHD for 10 h were included. The reduction in serum concentrations of vancomycin after 2 h of therapy was 26.65 ± 12.64% and at the end of dialysis was 45.78 ± 12.79%, higher in the 10-h PHD group, 57.70% (40, 48-64, 30%) ( = 0.037). The ratio of the area under the curve to minimal inhibitory concentration (AUC/MIC) at 24 h in the PHD group was significantly smaller than at 10 h ( = 0.047). In the logistic regression, PHD was a risk factor for an AUC/MIC ratio less than 400 (OR = 11.59, = 0.033), while a higher serum concentration of vancomycin at T0 was a protective factor (OR = 0.791, = 0.009). In conclusion, subtherapeutic concentrations of vancomycin in acute kidney injury (AKI) patients in dialysis were elevated and may be related to a higher risk of bacterial resistance and mortality, besides pointing out the necessity of additional doses of vancomycin during dialytic therapy, mainly in PHD.
本研究旨在评估脓毒症合并急性肾损伤（AKI）患者行间歇性血液透析（IHD）和长时间血液透析（PHD）时，万古霉素的清除率，并确定与治疗浓度不足相关的变量。这是一项在巴西某医院重症监护病房（ICU）进行的前瞻性研究。在开始透析治疗时、治疗 2 小时和 4 小时以及治疗结束时采集血样，以确定万古霉素的血清浓度，从而进行药代动力学评估和 PK/PD 模型构建。共纳入 27 例行 IHD 治疗的患者、17 例行 6 小时 PHD 治疗的患者和 11 例行 10 小时 PHD 治疗的患者。治疗 2 小时后，万古霉素血清浓度降低了 26.65±12.64%，透析结束时降低了 45.78±12.79%，10 小时 PHD 组降低幅度更高，为 57.70%（40，48-64，30%）（ = 0.037）。PHD 组 24 小时 AUC/MIC 比值显著小于 10 小时（ = 0.047）。在逻辑回归中，PHD 是 AUC/MIC 比值小于 400 的危险因素（OR=11.59， = 0.033），而 T0 时万古霉素血清浓度较高是保护因素（OR=0.791， = 0.009）。总之，透析中 AKI 患者万古霉素治疗浓度不足的情况较高，可能与细菌耐药和死亡率风险增加有关，提示在透析期间，特别是在 PHD 期间，需要追加万古霉素剂量。
