危重症患者氟康唑暴露不足：药代动力学分析与影响因素。
Suboptimal exposure to fluconazole in critically ill patients: Pharmacokinetic analysis and determinants.
机构信息
Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France; ICBMS CNRS 5246, Campus Lyon-Tech La Doua, Université de Lyon, Lyon, France.
Centre de Recherche Clinique, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France.
出版信息
Infect Dis Now. 2023 Mar;53(2):104630. doi: 10.1016/j.idnow.2022.10.002. Epub 2022 Oct 31.
OBJECTIVES
This study aims at evaluating fluconazole exposure in critically ill patients and identifying variables associated with the latter.
PATIENTS AND METHODS
This was a 2-year (2018-2019) retrospective multicenter cohort study. Adult patients > 18 years-old with at least one fluconazole concentration measurement during their ICU stay were included.
RESULTS
Twenty patients were included. Only 11 patients had a fluconazole trough concentration (Cmin) within the target range (≥15 mg/L). According to bivariable analysis, SOFA score, GGT, fluconazole clearance, Ke, and Vd, were independently associated with a decrease in fluconazole Cmin. The median loading dose required to achieve the Cmin target appeared to be greater in patients with higher SOFA or GGT level and in patients undergoing renal replacement therapy.
CONCLUSIONS
This study supports recommendation for routine fluconazole therapeutic drug monitoring in ICU patients so as to avoid underexposure, especially if SOFA score is ≥ 7 and/or GGT is ≥ 100 U/L.
目的
本研究旨在评估重症患者氟康唑的暴露情况，并确定与后者相关的变量。
患者与方法
这是一项为期 2 年（2018-2019 年）的回顾性多中心队列研究。纳入 ICU 期间至少有一次氟康唑浓度测量值的成年患者（>18 岁）。
结果
共纳入 20 名患者。仅有 11 名患者的氟康唑谷浓度（Cmin）在目标范围内（≥15mg/L）。根据单变量分析，SOFA 评分、GGT、氟康唑清除率、Ke 和 Vd 与氟康唑 Cmin 降低独立相关。SOFA 评分或 GGT 水平较高以及接受肾脏替代治疗的患者，实现 Cmin 目标所需的中位负荷剂量似乎更大。
结论
本研究支持对 ICU 患者常规进行氟康唑治疗药物监测的建议，以避免药物暴露不足，尤其是 SOFA 评分≥7 和/或 GGT≥100U/L 时。
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