Department of Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada.
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Perit Dial Int. 2022 Mar;42(2):171-176. doi: 10.1177/08968608211051579. Epub 2021 Oct 21.
Intraperitoneal (IP) vancomycin is recommended as one of the treatment options for gram-positive coverage in the management of peritoneal dialysis (PD)-associated peritonitis. There is a lack of literature supporting the optimal dose and approach to vancomycin therapeutic drug-level monitoring.
A retrospective chart review was conducted using the BC Renal Agency PROMIS Database and our hospital records from 1 June 2011 to 1 July 2019. Adult patients with PD-associated peritonitis who received IP vancomycin and had at least one serum vancomycin level drawn were included. All patients received a loading dose of 30 mg/kg, which was repeated every 3-5 days depending on PD modality. Serum vancomycin levels were drawn prior to the second vancomycin dose, then at the discretion of the prescriber. The primary end point was the rate of therapeutic serum vancomycin levels ≥15 mg/L.
Twenty-three episodes of PD-associated peritonitis in 20 patients met the eligibility criteria. Only 15/23 serum vancomycin levels were drawn appropriately after the first dose. Sixty per cent of these levels were subtherapeutic at <15 mg/L. All subsequent serum vancomycin levels were above the therapeutic target. Most peritonitis episodes (78%) achieved resolution of infection. Residual kidney function was not significantly correlated with serum vancomycin levels ( = 0.19).
An IP vancomycin regimen of 30 mg/kg every 3-5 days resulted in subtherapeutic serum vancomycin levels in most patients following the loading dose but therapeutic levels thereafter. A large percentage of vancomycin levels were drawn inappropriately due to misalignment of outpatient follow-up visits and timing of blood work.
腹腔内（IP）万古霉素被推荐作为治疗腹膜透析（PD）相关腹膜炎中革兰阳性覆盖的治疗选择之一。缺乏支持最佳剂量和万古霉素治疗药物水平监测方法的文献。
使用 BC 肾脏机构 PROMIS 数据库和我们医院的记录，对 2011 年 6 月 1 日至 2019 年 7 月 1 日期间的病历进行回顾性图表审查。纳入接受 IP 万古霉素治疗且至少有一次血清万古霉素水平检测的 PD 相关腹膜炎的成年患者。所有患者均接受 30mg/kg 的负荷剂量，根据 PD 方式，每 3-5 天重复一次。在第二次万古霉素剂量前、根据医嘱进行一次血清万古霉素水平检测。主要终点是治疗性血清万古霉素水平≥15mg/L 的比例。
20 名患者中有 23 例 PD 相关腹膜炎符合入选标准。仅在第一次剂量后，15/23 次血清万古霉素水平得到了适当的检测。这些水平中有 60%在<15mg/L 时低于治疗水平。所有随后的血清万古霉素水平均高于治疗目标。大多数腹膜炎发作（78%）感染得到了治愈。残余肾功能与血清万古霉素水平无显著相关性（=0.19）。
30mg/kg 的 IP 万古霉素方案，每 3-5 天一次，在负荷剂量后大多数患者的血清万古霉素水平低于治疗水平，但随后达到了治疗水平。由于门诊随访和血液检测时间的不匹配，很大比例的万古霉素水平检测不当。
