行血液透析患者中万古霉素检测方法的比较。

Comparison of vancomycin assays in patients undergoing hemodialysis.

机构信息

Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil; Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Campus Porto Alegre, RS, Brazil.

Hospital Moinhos de Vento, Serviço de Farmácia, Porto Alegre, RS, Brazil.

出版信息

Braz J Infect Dis. 2024 Sep-Oct;28(5):103869. doi: 10.1016/j.bjid.2024.103869. Epub 2024 Sep 16.

DOI:10.1016/j.bjid.2024.103869

PMID:39299299

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11439842/

Abstract

Vancomycin is a glycopeptide antibiotic mainly excreted by glomerular filtration. Therefore, patients undergoing hemodialysis tend to accumulate its crystalline degradation product, which has been associated with cross-reaction in commercial immunoassays. The aim of this study was to assess the performance of two commercial immunoassays for measuring vancomycin levels in patients undergoing hemodialysis. This method-comparison study enrolled patients undergoing hemodialysis at two hospitals in Porto Alegre, Brazil. Vancomycin serum concentrations measured by Chemiluminescent Microparticle Assay (CMIA) and measured by Kinetic Interaction of Microparticles in Solution (KIMS) were compared with Liquid Chromatography coupled with Tandem Mass Spectrometry (LC-MS/MS). A total of 64 samples from 42 patients and 54 samples from 23 patients were included in CMIA and KIMS groups. Both measurements were highly correlated with LC-MS/MS, with Spearman rank correlation coefficient r = 0.840 (p < 0.001) and r = 0.926 (p < 0.001), respectively. No deviation of linearity was observed (p = 0.81 and p = 0.49, respectively). The mean difference between CMIA and LC-MS/MS was -1.19 μg/mL and between KIMS and LC-MS/MS was -2.28 μg/mL. LC-MS/MS measured levels were, on average, 2.64 % higher than CMIA and 8.81 % higher than KIMS. CMIA and KIMS revealed accurate commercial methods to measure vancomycin serum concentrations in patients undergoing hemodialysis.

摘要

万古霉素是一种糖肽抗生素，主要通过肾小球滤过排泄。因此，接受血液透析的患者往往会积累其结晶降解产物，这与商业免疫分析中的交叉反应有关。本研究旨在评估两种商业免疫分析法在接受血液透析的患者中测量万古霉素水平的性能。这项方法比较研究纳入了巴西阿雷格里港的两家医院接受血液透析的患者。通过化学发光微粒子检测法（CMIA）和动力学相互作用的微粒子在溶液中检测法（KIMS）测量的万古霉素血清浓度与液相色谱串联质谱法（LC-MS/MS）进行比较。共纳入 42 名患者的 64 个样本和 23 名患者的 54 个样本分别纳入 CMIA 和 KIMS 组。两种测量方法均与 LC-MS/MS 高度相关，Spearman 秩相关系数 r = 0.840（p < 0.001）和 r = 0.926（p < 0.001）。均未观察到线性偏差（分别为 p = 0.81 和 p = 0.49）。CMIA 与 LC-MS/MS 之间的平均差异为-1.19μg/mL，KIMS 与 LC-MS/MS 之间的平均差异为-2.28μg/mL。LC-MS/MS 测量的水平平均比 CMIA 高 2.64%，比 KIMS 高 8.81%。CMIA 和 KIMS 显示了准确的商业方法来测量接受血液透析的患者的万古霉素血清浓度。