Department of Pharmacy, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China.
Department of Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China.
Medicine (Baltimore). 2021 Aug 13;100(32):e26889. doi: 10.1097/MD.0000000000026889.
Our purpose was to assess pediatricians' knowledge of augmented renal clearance (ARC).We conducted cross-sectional analyses of 500 pediatricians from 16 tertiary hospitals in Anhui Province, China. Pediatricians provided demographic information and were asked questions about their knowledge of ARC, including risk factors, evaluation tools, and the impact on patient prognosis, with a focus on the attitude and practice of pediatricians related to adjusting vancomycin regimens when ARC occurs.A total of 491 valid questionnaires were finally included, only 276 pediatricians stated that they "know about ARC." Compared with the "do not know about ARC" group, the "know about ARC" group was younger (43.7 ± 8.0 vs 48.0 ± 7.9, P < .001), and their main source of ARC knowledge was from social networking platforms. A total of 193 (70%) chose at least 4 of the following factors as risk factors for children with ARC: severe trauma, sepsis, burns, major surgery, lower disease severity, and hematological malignancies. A total of 110 (40%) and 105 (38%) pediatricians chose the Schwartz formula and cystatin C, respectively, as the indicators to evaluate the renal function of ARC children. Concerning the estimated glomerular filtration rate threshold to identify ARC children, 201 (73%) pediatricians chose 130 mL/min/1.73 m2, while 55 (20%) chose "age-dependent ARC thresholds." Overall, 220 (80%) respondents indicated that ARC would impact the treatment effect of vancomycin, but 149/220 (68%) were willing to adjust the vancomycin regimen; only 22/149 (8%) considered that the dose should be increased, but no one knew how to increase. Regarding the prognosis of ARC children, all respondents chose "unclear."ARC is relatively common in critically ill children, but pediatricians do not know much about it, as most of the current knowledge is based on adult studies. Furthermore, ARC is often confused with acute kidney injury, which would lead to very serious treatment errors. Therefore, more pediatric studies about ARC are needed, and ARC should be written into official pediatric guidelines as soon as possible to provide reference for pediatricians.
我们的目的是评估儿科医生对增强型肾清除率（ARC）的认识。我们对来自中国安徽省 16 家三级医院的 500 名儿科医生进行了横断面分析。儿科医生提供了人口统计学信息，并被问及有关 ARC 知识的问题，包括危险因素、评估工具以及对患者预后的影响，重点关注儿科医生在 ARC 发生时调整万古霉素方案的态度和实践。最终共纳入 491 份有效问卷，只有 276 名儿科医生表示“了解 ARC”。与“不了解 ARC”组相比，“了解 ARC”组更年轻（43.7±8.0 岁 vs 48.0±7.9 岁，P<0.001），其 ARC 知识的主要来源是社交网络平台。共有 193 名（70%）儿科医生选择了以下至少 4 个因素作为 ARC 患儿的危险因素：严重创伤、脓毒症、烧伤、大手术、疾病严重程度较低和血液恶性肿瘤。共有 110 名（40%）和 105 名（38%）儿科医生分别选择 Schwartz 公式和胱抑素 C 作为评估 ARC 患儿肾功能的指标。关于识别 ARC 患儿的估计肾小球滤过率阈值，201 名（73%）儿科医生选择 130 mL/min/1.73 m2，而 55 名（20%）选择“年龄依赖性 ARC 阈值”。总体而言，220 名（80%）受访者表示 ARC 会影响万古霉素的治疗效果，但 149/220（68%）愿意调整万古霉素方案；只有 22/149（8%）认为应该增加剂量，但没有人知道如何增加。关于 ARC 患儿的预后，所有受访者均选择“不清楚”。ARC 在危重症患儿中较为常见，但儿科医生对此了解甚少，因为目前的大部分知识都是基于成人研究。此外，ARC 常与急性肾损伤混淆，这将导致非常严重的治疗错误。因此，需要开展更多关于 ARC 的儿科研究，并尽快将 ARC 写入官方儿科指南，为儿科医生提供参考。
