Deacon Erin, Canney Mark, McCormick Brendan, Ramsay Tim, Biyani Mohan, Brown Pierre Antoine, Zimmerman Deborah
Faculty of Medicine, University of Ottawa, Ontario, Canada.
Department of Medicine, Ottawa Hospital, Faculty of Medicine, University of Ottawa and the Kidney Research Centre of the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Kidney Int Rep. 2023 Sep 17;8(12):2646-2653. doi: 10.1016/j.ekir.2023.09.013. eCollection 2023 Dec.
Intraperitoneal (IP) vancomycin is often first-line empiric therapy and then maintenance therapy for peritoneal dialysis (PD) peritonitis. However, how vancomycin serum levels correlate with clinical outcomes remains unclear.
We conducted a retrospective single-center adult cohort study of 98 patients with PD peritonitis treated with IP vancomycin between January 2016 and May 2022. The association between nadir vancomycin level and cure was evaluated in a logistic regression model, first unadjusted and then adjusted for age, sex, weight, glomerular filtration rate (GFR), and total number of days on PD. Vancomycin was assessed both as a continuous exposure (per 1 mg/l increase) and as a categorical exposure (<15 mg/l vs. ≥15 mg/l). A receiver operating characteristic curve (ROC) was created to explore nadir vancomycin level thresholds in an attempt to identify an optimal target level during treatment.
Of the patients, 81% achieved cure, and patients with nadir vancomycin level ≥15 mg/l were 7.5 times more likely to experience cure compared to those with a nadir level <15 mg/l (odds ratio [OR] 7.58, 95% confidence interval [CI] 1.71-33.57, = 0.008). Weight, GFR, days on PD, sex, and age were not independently associated with outcome. The vancomycin level with the greatest discriminatory capacity for cure on the ROC analysis was 14.4 mg/l.
Increasing IP vancomycin serum levels are associated with increased odds of cure; and maintaining vancomycin serum levels above 14-15 mg/l throughout the course of PD peritonitis treatment is likely to improve clinical outcomes.
腹腔内（IP）注射万古霉素通常是腹膜透析（PD）腹膜炎的一线经验性治疗药物，随后作为维持治疗药物。然而，万古霉素血清水平与临床结局之间的相关性仍不明确。
我们对2016年1月至2022年5月期间接受IP万古霉素治疗的98例PD腹膜炎成年患者进行了一项回顾性单中心队列研究。在逻辑回归模型中评估最低万古霉素水平与治愈之间的关联，首先进行未调整分析，然后针对年龄、性别、体重、肾小球滤过率（GFR）和PD总天数进行调整。万古霉素既作为连续暴露因素（每增加1 mg/l）进行评估，也作为分类暴露因素（<15 mg/l与≥15 mg/l）进行评估。绘制受试者工作特征曲线（ROC）以探索最低万古霉素水平阈值，试图确定治疗期间的最佳目标水平。
在这些患者中，81%实现了治愈，最低万古霉素水平≥15 mg/l的患者治愈的可能性是最低水平<15 mg/l患者的7.5倍（优势比[OR] 7.58，95%置信区间[CI] 1.71 - 33.57，P = 0.008）。体重、GFR、PD天数、性别和年龄与结局无独立关联。ROC分析中对治愈具有最大鉴别能力的万古霉素水平为14.4 mg/l。
IP万古霉素血清水平升高与治愈几率增加相关；在PD腹膜炎治疗全过程中将万古霉素血清水平维持在14 - 15 mg/l以上可能会改善临床结局。
