使用慢性肾脏病流行病学合作组方程确定的增强肾清除率的外科病房患者中万古霉素剂量的优化。
Optimize Vancomycin Dose in Surgical Ward Patients with Augmented Renal Clearance Determined by Chronic Kidney Disease Epidemiology Collaboration Equation.
作者信息
Chen Li-Yu, Wang Chen-Yu, Lin Chi-Ying, Tsai Ming-Jui, Shen Wei-Hsun, Li Pei-Jhih, Liao Lin-Chu, Huang Chih-Fen, Wu Chien-Chih
机构信息
Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan.
出版信息
Infect Drug Resist. 2024 Sep 27;17:4195-4203. doi: 10.2147/IDR.S477414. eCollection 2024.
BACKGROUND
In the field of postoperative care, infections caused by Gram-positive bacteria pose a major clinical challenge. Vancomycin is a key therapeutic agent whose efficacy is greatly influenced by renal function, particularly by augmented renal clearance (ARC). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) is an easy and commonly used method to predict ARC; however, it is not well studied to determine vancomycin dose. In this study, we examined the effectiveness of the CKD-EPI equation in determining ARC and optimizing the dose of vancomycin for surgical ward patients.
METHODOLOGY
A retrospective observational study was conducted to examine 158 surgical ward patients receiving vancomycin. Data on demographics, medical history, and vancomycin dosing were collected. Renal function was evaluated using the CKD-EPI equation, with ARC defined as eGFR ≥ 96.5 mL/min/1.73 m. Vancomycin pharmacokinetics were calculated using the ClinCalc tool.
RESULTS
ARC was in 54% of the patients. Compared with patients without ARC, those with ARC were younger and had lower serum creatinine levels. They also required higher vancomycin doses but had lower trough concentrations and 24-hour area-under-the-curve values. A significant correlation was observed between eGFR and vancomycin clearance, with eGFR > 96.5 mL/min/1.73 m necessitating higher vancomycin doses (>45 mg/kg/day) to achieve the desired area under the curve to minimum inhibitory concentration ratio.
CONCLUSION
For surgical ward patients with CKD-EPI eGFR ≥ 96.5 mL/min/1.73 m, a vancomycin dosage of >45 mg/kg/day may be recommended to reach effective therapeutic levels. Overall, this study emphasizes the importance of tailoring vancomycin therapy depending on renal function to ensure efficacy and mitigate the risk of antimicrobial resistance in surgical ward patients.
背景
在术后护理领域，革兰氏阳性菌引起的感染构成了重大的临床挑战。万古霉素是一种关键治疗药物，其疗效受肾功能，尤其是肾脏清除率增加（ARC）的显著影响。慢性肾脏病流行病学协作组（CKD-EPI）估算的肾小球滤过率（eGFR）是预测ARC的一种简便且常用的方法；然而，在确定万古霉素剂量方面，其研究尚不充分。在本研究中，我们考察了CKD-EPI方程在确定ARC以及优化外科病房患者万古霉素剂量方面的有效性。
方法
开展一项回顾性观察研究，纳入158例接受万古霉素治疗的外科病房患者。收集人口统计学、病史及万古霉素给药的数据。使用CKD-EPI方程评估肾功能，ARC定义为eGFR≥96.5 mL/min/1.73 m²。使用ClinCalc工具计算万古霉素的药代动力学参数。
结果
54%的患者存在ARC。与无ARC的患者相比，有ARC的患者更年轻，血清肌酐水平更低。他们也需要更高剂量的万古霉素，但谷浓度和24小时曲线下面积值更低。观察到eGFR与万古霉素清除率之间存在显著相关性，eGFR>96.5 mL/min/1.73 m²时需要更高剂量的万古霉素（>45 mg/kg/天）才能达到理想的曲线下面积与最低抑菌浓度比值。
结论
对于CKD-EPI eGFR≥96.5 mL/min/1.73 m²的外科病房患者，可能建议万古霉素剂量>45 mg/kg/天以达到有效的治疗水平。总体而言，本研究强调了根据肾功能调整万古霉素治疗以确保疗效并降低外科病房患者抗菌药物耐药风险的重要性。
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