Rio-No Laura, Sorli Luisa, Arderiu-Formenti Alba, De Antonio Marta, Martorell Lucas, Subirana Isaac, Puig Lluis, Alier Albert, Gómez-Junyent Joan, Pérez-Prieto Daniel, Luque Sonia
Pharmacy Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain.
Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain.
Trop Med Infect Dis. 2023 Feb 13;8(2):113. doi: 10.3390/tropicalmed8020113.
Vancomycin is used for the treatment of bone and joint infections (BJI), but scarce information is available about its pharmacokinetic/pharmacodynamic (PK/PD) characteristics. We aimed to identify the risk factors associated with the non-achievement of an optimal PK/PD target in the first therapeutic drug monitoring (TDM). Methods: A retrospective study was conducted in a tertiary hospital from January 2020 to January 2022. Patients with BJI and TDM of vancomycin on day 2 of treatment were included. Initial vancomycin fixed doses (1 g every 8 h or 12 h) was decided by the responsible doctors. According to TDM results, dosage adjustments were performed. An AUC/MIC < 400 mg × h/L, between 400 and 600 mg × h/L and >600 mg × h/L, were defined as suboptimal, optimal and supratherapeutic, respectively. Patients were grouped into these three categories. Demographic, clinical and PK characteristics were compared between groups. Nephrotoxicity at the end of treatment was assessed. Results: A total of 94 patients were included: 22 (23.4%), 42 (44.7%) and 30 (31.9%) presented an infratherapeutic, optimal and supratherapeutic PK/PD targets, respectively. A younger age and initial vancomycin dose <40 mg/kg/day were predictive factors for achieving a suboptimal PK/PD target, while older age, higher serum-creatinine and dose >40 mg/kg/day were associated with overexposure. The nephrotoxicity rate was 22.7%. More than 50% of patients did not achieve an optimal PK/PD. Considering age, baseline serum-creatinine and body weight, TDM is required to readily achieve an optimal and safe exposure.
万古霉素用于治疗骨与关节感染（BJI），但其药代动力学/药效学（PK/PD）特征方面的信息较少。我们旨在确定在首次治疗药物监测（TDM）中未达到最佳PK/PD目标的相关危险因素。方法：2020年1月至2022年1月在一家三级医院进行了一项回顾性研究。纳入治疗第2天进行万古霉素TDM的BJI患者。初始万古霉素固定剂量（每8小时或12小时1克）由负责医生决定。根据TDM结果进行剂量调整。AUC/MIC＜400mg×h/L、400至600mg×h/L和＞600mg×h/L分别定义为亚最佳、最佳和超治疗水平。患者被分为这三类。比较各组的人口统计学、临床和PK特征。评估治疗结束时的肾毒性。结果：共纳入94例患者：分别有22例（23.4%）、42例（44.7%）和30例（31.9%）呈现亚治疗、最佳和超治疗PK/PD目标。年龄较小和初始万古霉素剂量＜40mg/kg/天是达到亚最佳PK/PD目标的预测因素，而年龄较大、血清肌酐较高和剂量＞40mg/kg/天与暴露过度相关。肾毒性发生率为22.7%。超过5０%的患者未达到最佳PK/PD。考虑年龄、基线血清肌酐和体重，需要进行TDM以轻易实现最佳和安全暴露。
