Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
BMC Infect Dis. 2021 Nov 24;21(1):1182. doi: 10.1186/s12879-021-06840-y.
Vancomycin is a commonly used antibiotic in critically ill patients for various indications. Critical illness imposes pharmacokinetic-pharmacodynamics challenges, which makes optimizing vancomycin in this population cumbersome. Data are scarce on the clinical impact of time to therapeutic trough levels of vancomycin in critically ill patients. This study aims to evaluate the timing to achieve therapeutic trough level of vancomycin on 30-day mortality in critically ill patients.
A retrospective cohort study was conducted for all adult critically ill patients with confirmed Gram-positive infection who received IV vancomycin between January 1, 2017, and December 31, 2020. We compared early (< 48 h) versus late (≥ 48 h) attainment of vancomycin therapeutic trough levels. The primary outcome was the 30-day mortality in critically ill patients. Secondary outcomes were the development of resistant organisms, microorganisms eradication within 4-5 days of vancomycin initiation, acute kidney injury (AKI), and length of stay (LOS). Propensity score-matched (1:1 ratio) used based on patient's age, serum creatinine, and albumin values at baseline.
A total of 326 patients were included; 110 patients attained the therapeutic trough levels within 48 h of vancomycin initiation. Late achievement of the therapeutic trough levels was associated with higher 30-day mortality (HR: 2.54; 95% CI [1.24-5.22]; p = 0.01). Additionally, patients who achieved therapeutic trough levels of vancomycin late were more likely to develop AKI (OR = 2.59; 95% CI [1.01-6.65]; p = 0.04). Other outcomes were not statistically significant between the two groups.
Early achievement of vancomycin therapeutic levels in patients with confirmed Gram-positive infection was associated with possible survival benefits.
万古霉素是危重症患者治疗各种感染的常用抗生素。危重症会带来药代动力学-药效学方面的挑战，这使得在这类人群中优化万古霉素的使用变得复杂。关于在危重症患者中达到万古霉素治疗谷浓度的时间对临床结局的影响的数据较为有限。本研究旨在评估达到万古霉素治疗谷浓度的时间对危重症患者 30 天死亡率的影响。
对 2017 年 1 月 1 日至 2020 年 12 月 31 日期间接受静脉万古霉素治疗且确诊有革兰阳性感染的所有成年危重症患者进行回顾性队列研究。我们比较了早期（<48 小时）和晚期（≥48 小时）达到万古霉素治疗谷浓度的情况。主要结局是危重症患者的 30 天死亡率。次要结局是耐药菌的产生、万古霉素开始使用后 4-5 天内微生物的清除、急性肾损伤（AKI）和住院时间（LOS）。根据患者的年龄、基线时的血清肌酐和白蛋白值进行倾向性评分匹配（1:1 比例）。
共纳入 326 例患者，其中 110 例患者在万古霉素开始使用后 48 小时内达到了治疗谷浓度。晚期达到治疗谷浓度与较高的 30 天死亡率相关（HR：2.54；95%CI[1.24-5.22]；p=0.01）。此外，晚期达到万古霉素治疗谷浓度的患者更有可能发生 AKI（OR=2.59；95%CI[1.01-6.65]；p=0.04）。两组间其他结局无统计学差异。
在确诊有革兰阳性感染的患者中，早期达到万古霉素治疗水平可能与生存获益相关。
