连续静脉-静脉血液滤过治疗危重症患者时万古霉素持续输注与间断输注的前瞻性干预研究。
Continuous infusion versus intermittent infusion of vancomycin in critically ill patients undergoing continuous venovenous hemofiltration: a prospective interventional study.
机构信息
Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215002, China.
Emergent Intensive Care Unit, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215002, China.
出版信息
BMC Infect Dis. 2022 Aug 2;22(1):667. doi: 10.1186/s12879-022-07618-6.
BACKGROUND
A prospective interventional study comparing outcomes in critically ill patients receiving intermittent infusion (II) or continuous infusion (CI) of vancomycin during continuous venovenous hemofiltration (CVVH) is lacking. The objective of this study was to compare the pharmacokinetic/pharmacodynamics (PK/PD) target attainment, therapeutic efficacy and safety among critically ill patients who received CI or II of vancomycin in a prospective interventional trial and to explore the correlations of effluent flow rate (EFR) with PK/PD indices.
METHODS
This prospective interventional study was conducted in two independent intensive care units (ICUs) from February 2021 to January 2022. Patients in one ICU were assigned to receive CI (intervention group) of vancomycin, whereas patients in the other ICU were assigned to receive II regimen (control group). The primary outcome was to compare the PK/PD target attainment, including target concentration and target area under the curve over 24 h to minimum inhibitory concentration (AUC/MIC).
RESULTS
Overall target attainment of PK/PD indices was higher with CI compared with II, irrespective of target concentration (78.7% vs. 40.5%; P < 0.05) or AUC/MIC (53.2% vs. 28.6%; P < 0.05). There were no significant differences in clinical success (72.2% vs. 50.0%; P = 0.183) and microbiological success (83.3% vs. 75.0%, P = 0.681) between the patients treated with CI or II of vancomycin. Adverse reactions occurred at similar rates (0.0% vs. 4.4%; P = 0.462), and mortality between the two modalities was also not significant different (21.7% vs. 17.9%; P = 0.728). Correlation analysis showed a weak to moderately inverse correlation of EFR with observed concentration (r = - 0.3921, P = 0.01) and AUC/MIC (r = - 0.3811, P = 0.013) in the II group, whereas the correlation between EFR and observed concentration (r = - 0.5711, P < 0.001) or AUC/MIC (r = - 0.5458, P < 0.001) in the CI group was stronger.
CONCLUSION
As compared to II, CI of vancomycin in critically ill patients undergoing CVVH was associated with improved attainment of PK/PD indices. Furthermore, the inverse correlation of PK/PD indices with EFR was stronger among patients treated with CI of vancomycin. Trial registration The trial was registered in the Chinese clinical trial registration center (21/01/2021-No. ChiCTR2100042393).
背景
目前尚缺乏比较连续静脉-静脉血液滤过（CVVH）期间间断输注（II）与连续输注（CI）万古霉素治疗危重症患者结局的前瞻性干预研究。本研究旨在比较接受 CI 或 II 万古霉素治疗的危重症患者的药代动力学/药效学（PK/PD）目标达成、治疗效果和安全性，并探讨流出液流速（EFR）与 PK/PD 指标的相关性。
方法
这是一项于 2021 年 2 月至 2022 年 1 月在两个独立的重症监护病房（ICU）进行的前瞻性干预研究。一个 ICU 的患者被分配接受 CI（干预组）万古霉素，而另一个 ICU 的患者被分配接受 II 方案（对照组）。主要结局是比较 PK/PD 指标的目标达成率，包括目标浓度和 24 小时内最低抑菌浓度（MIC）的目标 AUC/MIC。
结果
与 II 相比，CI 万古霉素的 PK/PD 指标的总体目标达成率更高，包括目标浓度（78.7% vs. 40.5%；P<0.05）或 AUC/MIC（53.2% vs. 28.6%；P<0.05）。CI 或 II 万古霉素治疗的患者之间的临床成功率（72.2% vs. 50.0%；P=0.183）和微生物学成功率（83.3% vs. 75.0%；P=0.681）无显著差异。不良反应发生率相似（0.0% vs. 4.4%；P=0.462），两种方式的死亡率也无显著差异（21.7% vs. 17.9%；P=0.728）。相关性分析显示，EFR 与 II 组的实测浓度（r=-0.3921，P=0.01）和 AUC/MIC（r=-0.3811，P=0.013）呈弱至中度负相关，而 EFR 与实测浓度（r=-0.5711，P<0.001）或 AUC/MIC（r=-0.5458，P<0.001）在 CI 组之间的相关性更强。
结论
与 II 相比，CVVH 期间危重症患者 CI 万古霉素治疗与 PK/PD 指标的改善达成有关。此外，在接受 CI 万古霉素治疗的患者中，PK/PD 指标与 EFR 的负相关性更强。
试验注册
本试验在中国临床试验注册中心注册（21/01/2021-编号 ChiCTR2100042393）。
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