School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
Laboratory of Emerging Infectious Diseases (LEID), School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
Ther Drug Monit. 2021 Dec 1;43(6):807-811. doi: 10.1097/FTD.0000000000000907.
This study aimed to evaluate the utility of a commercial kit used to measure serum vancomycin concentrations to determine vancomycin concentrations in cerebrospinal fluid (CSF) samples and evaluate CSF penetration when administered as a continuous high-dose infusion in patients with nosocomial ventriculitis.
This study included patients with external ventricular drain infection who were admitted to the intensive care unit between January 2018 and September 2020. After validation, CSF samples from 33 patients were collected. All patients received 30 mg/kg of vancomycin as a loading dose followed by 60 mg/kg as a maintenance dose in continuous infusion; all CSF samples were collected at least 48 hours after the first dose.
Thirty-three patients were enrolled in this study. The median serum creatinine level was 0.66 mg/dL (0.5-0.92; n = 30), and median creatinine clearance was 119.2 mL/min (64.6-138.4; n = 13). The median serum vancomycin 24-hour area under the curve (AUC24h) was 838 mg*h/L (515-1010). The median CSF vancomycin concentration was 5.20 mg/L (1.95-12.4). Median serum vancomycin concentration was 34.9 mg/L (21.47-42.1), and median CSF/serum ratio was 18.6% (8.4-41.5). Acute renal injury occurred in 21% (n = 7) of the patients by the end of the therapy. In addition, the vancomycin CSF/serum ratio was positively correlated with the median serum creatinine level (r = 0.670; P = 0.004).
Commercial vancomycin kits used to measure serum samples may be used to evaluate vancomycin concentrations in the CSF. Vancomycin penetration into CSF was 18.6%.
本研究旨在评估一种用于测量血清万古霉素浓度的商业试剂盒在确定医院获得性脑室炎患者连续高剂量输注时脑脊液（CSF）样本中的万古霉素浓度方面的效用，并评估其 CSF 穿透率。
本研究纳入了 2018 年 1 月至 2020 年 9 月期间入住重症监护病房的患有外部脑室引流感染的患者。经过验证后，共采集了 33 例患者的 CSF 样本。所有患者均给予 30mg/kg 的万古霉素负荷剂量，然后以 60mg/kg 的剂量持续输注；所有 CSF 样本均在首剂后至少 48 小时采集。
本研究共纳入 33 例患者。中位血清肌酐水平为 0.66mg/dL（0.5-0.92；n=30），中位肌酐清除率为 119.2mL/min（64.6-138.4；n=13）。中位血清万古霉素 24 小时 AUC24h 为 838mg*h/L（515-1010）。中位 CSF 万古霉素浓度为 5.20mg/L（1.95-12.4）。中位血清万古霉素浓度为 34.9mg/L（21.47-42.1），中位 CSF/血清比值为 18.6%（8.4-41.5）。治疗结束时，21%（n=7）的患者发生急性肾损伤。此外，CSF/血清比值与中位血清肌酐水平呈正相关（r=0.670；P=0.004）。
用于测量血清样本的商业万古霉素试剂盒可用于评估 CSF 中的万古霉素浓度。万古霉素穿透 CSF 的比例为 18.6%。
