Department of Pharmacy, University of Kentucky Healthcare, Lexington, Kentucky, USA.
Department of Pharmacy, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA.
Pediatr Pulmonol. 2023 Jan;58(1):239-245. doi: 10.1002/ppul.26190. Epub 2022 Oct 28.
The primary objective of this study was to compare the occurrence of acute kidney injury (AKI) in patients with cystic fibrosis (CF) receiving intravenous (IV) vancomycin monitored through single serum trough concentrations and two-point estimated area under the curve (AUC). Time to next exacerbation and return to baseline lung function were also assessed.
A retrospective review was conducted in patients of all ages with CF admitted to the University of Kentucky who received IV vancomycin between October 2015 and January 2021. Patients were excluded if they received less than 5 days of IV vancomycin therapy.
A total of 113 adults and 42 pediatric encounters met the inclusion criteria. There was no statistically significant difference in occurrence of AKI, however, all grade 2-3 AKIs were in the serum through the monitoring group. Adult patients monitored with AUC also had a higher return to baseline lung function over trough monitoring (86% vs. 57%) (p = 0.002). There was not a statistically significant difference in time to the next exacerbation in either group.
Adult patients with CF experienced less severe AKIs when monitored with AUC versus trough. The results of this study indicate that AUC monitoring may enhance the efficacy of IV vancomycin in adult patients with CF.
本研究的主要目的是比较通过单次血清谷浓度和两点估计的 AUC 监测接受静脉注射（IV）万古霉素的囊性纤维化（CF）患者发生急性肾损伤（AKI）的情况。还评估了下一次加重的时间和恢复到基线肺功能的情况。
对 2015 年 10 月至 2021 年 1 月期间在肯塔基大学接受 IV 万古霉素治疗的所有年龄段的 CF 患者进行了回顾性审查。如果患者接受的 IV 万古霉素治疗少于 5 天，则将其排除在外。
共有 113 例成人和 42 例儿科患者符合纳入标准。虽然 AKI 的发生率没有统计学上的显著差异，但通过监测组所有 2-3 级 AKI 都在血清中。接受 AUC 监测的成年患者在谷浓度监测时恢复到基线肺功能的比例更高（86%对 57%）（p=0.002）。两组之间的下一次加重时间没有统计学上的显著差异。
与谷浓度监测相比，接受 AUC 监测的 CF 成年患者发生 AKI 的严重程度较低。这项研究的结果表明，AUC 监测可能会提高 IV 万古霉素在 CF 成年患者中的疗效。
