Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan.
Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan.
J Infect Chemother. 2022 Feb;28(2):199-205. doi: 10.1016/j.jiac.2021.10.008. Epub 2021 Oct 19.
The purpose of this study was to evaluate the clinical applicability of urinary creatinine clearance (CrCl) for determining the initial dose of vancomycin (VCM) in critically ill patients and to assess VCM trough plasma concentration/maintenance daily dose (C/D) ratio in patients with augmented renal clearance (ARC).
As the primary outcome measure, correlations between estimated renal function and the VCM C/D ratio were compared using the following formulas: CrCl, Cockcroft-Gault equation (eCrCl) and KineticGFR equation (KeGFR). Patients were divided into those with or without changes in renal function. The patients were further classified based on the presence or absence of ARC. The secondary outcome was the comparison of VCM C/D ratio between ARC and Non-ARC patients.
A total of 65 patients were enrolled for analysis. In all groups, CrCl tended to correlate better with the VCM C/D ratio than eCrCl and KeGFR. A significantly lower VCM C/D ratio was observed in patients with persistent ARC than in the Non-ARC group (0.24 versus 0.52 kg/L).
The clinical applicability of CrCl for the initial dosing design of VCM in critically ill patients was shown. Furthermore, the results indicated that patients with persistent ARC required a higher VCM dose than Non-ARC patients. Although our findings are limited, they have a value for further verification.
本研究旨在评估尿肌酐清除率（CrCl）在确定危重症患者万古霉素（VCM）初始剂量方面的临床适用性，并评估伴有代偿性肾清除（ARC）患者的万古霉素谷浓度/维持日剂量（C/D）比值。
作为主要的结局测量指标，比较了以下公式估计的肾功能与万古霉素 C/D 比值之间的相关性：CrCl、 Cockcroft-Gault 方程（eCrCl）和 KineticGFR 方程（KeGFR）。将患者分为肾功能有变化和无变化两组。进一步根据是否存在 ARC 将患者进行分类。次要结局是比较 ARC 和非 ARC 患者之间的万古霉素 C/D 比值。
共纳入 65 例患者进行分析。在所有组中，CrCl 与万古霉素 C/D 比值的相关性均优于 eCrCl 和 KeGFR。与非 ARC 组相比，持续存在 ARC 的患者万古霉素 C/D 比值显著降低（0.24 与 0.52 kg/L）。
本研究表明 CrCl 可用于指导危重症患者初始万古霉素剂量设计。此外，结果表明持续存在 ARC 的患者需要更高的万古霉素剂量。尽管我们的发现有限，但它们具有进一步验证的价值。
