Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China.
Front Cell Infect Microbiol. 2023 Apr 3;13:1117717. doi: 10.3389/fcimb.2023.1117717. eCollection 2023.
Optimal vancomycin trough concentrations and dosages remain controversial in sepsis children. We aim to investigate vancomycin treatment outcomes with a dosage of 40-60 mg/kg/d and corresponding trough concentrations in children with Gram-positive bacterial sepsis from a clinical perspective.
Children diagnosed with Gram-positive bacterial sepsis and received intravenous vancomycin therapy between January 2017 and June 2020 were enrolled retrospectively. Patients were categorized as success and failure groups according to treatment outcomes. Laboratory, microbiological, and clinical data were collected. The risk factors for treatment failure were analyzed by logistic regression.
In total, 186 children were included, of whom 167 (89.8%) were enrolled in the success group and 19 (10.2%) in the failure group. The initial and mean vancomycin daily doses in failure group were significantly higher than those in success group [56.9 (IQR =42.1-60.0) . 40.5 (IQR =40.0-57.1), P=0.016; 57.0 (IQR =45.8-60.0) . 50.0 (IQR =40.0-57.6) mg/kg/d, P=0.012, respectively] and median vancomycin trough concentrations were similar between two groups [6.9 (4.0-12.1) .7.3 (4.5-10.6) mg/L, P=0.568)]. Moreover, there was no significant differences in treatment success rate between vancomycin trough concentrations ≤15 mg/L and >15 mg/L (91.2% . 75.0%, P=0.064). No vancomycin-related nephrotoxicity adverse effects occurred among all enrolled patients. Multivariate analysis revealed that a PRISM III score ≥10 (OR =15.011; 95% CI: 3.937-57.230; P<0.001) was the only independent clinical factor associated with increased incidence of treatment failure.
Vancomycin dosages of 40-60 mg/kg/d are effective and have no vancomycin-related nephrotoxicity adverse effects in children with Gram-positive bacterial sepsis. Vancomycin trough concentrations >15 mg/L are not an essential target for these Gram-positive bacterial sepsis patients. PRISM III scores ≥10 may serve as an independent risk factor for vancomycin treatment failure in these patients.
在脓毒症儿童中，万古霉素的最佳谷浓度和剂量仍存在争议。我们旨在从临床角度研究革兰氏阳性菌败血症患儿万古霉素剂量为 40-60mg/kg/d 时的治疗效果及其相应的谷浓度。
回顾性纳入 2017 年 1 月至 2020 年 6 月期间诊断为革兰氏阳性菌败血症并接受静脉万古霉素治疗的患儿。根据治疗结果将患儿分为成功组和失败组。收集实验室、微生物学和临床数据。采用 logistic 回归分析治疗失败的危险因素。
共纳入 186 例患儿，其中 167 例（89.8%）患儿纳入成功组，19 例（10.2%）患儿纳入失败组。失败组患儿初始及平均万古霉素日剂量显著高于成功组[56.9（IQR=42.1-60.0） vs. 40.5（IQR=40.0-57.1）mg/kg/d，P=0.016；57.0（IQR=45.8-60.0） vs. 50.0（IQR=40.0-57.6）mg/kg/d，P=0.012]，而两组患儿万古霉素谷浓度中位数无显著差异[6.9（4.0-12.1） vs. 7.3（4.5-10.6）mg/L，P=0.568]。此外，万古霉素谷浓度≤15mg/L 和>15mg/L 患儿的治疗成功率无显著差异[91.2% vs. 75.0%，P=0.064]。所有纳入患儿均未发生万古霉素相关性肾毒性不良反应。多因素分析显示，PRISM III 评分≥10（OR=15.011；95%CI：3.937-57.230；P<0.001）是与治疗失败发生率增加相关的唯一独立临床因素。
对于革兰氏阳性菌败血症患儿，40-60mg/kg/d 的万古霉素剂量有效，且无万古霉素相关性肾毒性不良反应。万古霉素谷浓度>15mg/L 并非此类革兰氏阳性菌败血症患儿的必要目标。PRISM III 评分≥10 可能是此类患儿万古霉素治疗失败的独立危险因素。
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