Haglund Rasmus, Tornberg Ulrika, Claesson Ann-Charlotte, Freyhult Eva, Hailer Nils P
Orthopaedics/Department of Surgical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden.
Science for Life Laboratory, Department of Cell and Molecular Biology, National Bioinformatics Infrastructure Sweden, Uppsala University, SE-752 37 Uppsala, Sweden.
Antibiotics (Basel). 2024 Dec 18;13(12):1226. doi: 10.3390/antibiotics13121226.
: Vancomycin is commonly used in the treatment of periprosthetic joint infection (PJI), and trough concentrations are measured to ascertain that they are within the therapeutic range. It has not been investigated what proportion of vancomycin concentrations during treatment of PJI patients is accurately within this range, how many dose adjustments are commonly needed, and which patient factors predispose towards aberrations from the desired range. : In this single-center cohort study, we investigated vancomycin trough concentrations in 108 patients with surgically treated PJI who received IV administered vancomycin treatment post-operatively. Patients were identified in our local arthroplasty register, and data beyond what was available in the register were collected from electronic medical charts. : Of the final study cohort, 41% were women, and the median age was 71 (IQR 63-79) years. Most patients had PJI of the hip (73%), the majority (54%) underwent a debridement, antibiotics and implant retention (DAIR) procedure prior to vancomycin treatment, and 39% received vancomycin-loaded bone cement during the preceding revision procedure. Of 791 vancomycin trough measurements, only 58.2% were within the target range of 15-20 mg/L, 18.5% were below, and 23.4% were above. A total of 71% of all patients required at least one dose adjustment, and the median length of vancomycin treatment was 8 days. We observed positive correlations of vancomycin trough concentrations with both age (Spearman's rho = 0.35, < 0.001) and pre-treatment creatinine concentrations (Spearman's rho = 0.34, < 0.001), but no statistically significant difference between patients who had received vancomycin-loaded bone cement and those who had not. : In our PJI patients, a high proportion of vancomycin trough concentrations were outside the therapeutic range, despite adherence to local and national guidelines. We can also confirm that caution needs to be exerted in patients of advanced age and those with compromised kidney function. Alternative broad-spectrum antibiotics that do not require as extensive therapeutic drug monitoring should be further explored.
万古霉素常用于治疗人工关节周围感染（PJI），通过测量谷浓度来确定其是否在治疗范围内。目前尚未研究PJI患者治疗期间万古霉素浓度准确处于该范围内的比例、通常需要进行多少次剂量调整以及哪些患者因素易导致偏离理想范围。
在这项单中心队列研究中，我们调查了108例接受手术治疗的PJI患者术后静脉注射万古霉素治疗时的万古霉素谷浓度。患者通过我们当地的关节置换登记册确定，并从电子病历中收集登记册中未提供的数据。
最终研究队列中，41%为女性，中位年龄为71岁（四分位间距63 - 79岁）。大多数患者为髋关节PJI（73%），多数（54%）在万古霉素治疗前接受了清创、抗生素和保留植入物（DAIR）手术，39%在之前的翻修手术中接受了载万古霉素骨水泥治疗。在791次万古霉素谷浓度测量中，只有58.2%在15 - 20mg/L的目标范围内，18.5%低于该范围，23.4%高于该范围。所有患者中共有71%至少需要进行一次剂量调整，万古霉素治疗的中位时长为8天。我们观察到万古霉素谷浓度与年龄（斯皮尔曼相关系数ρ = 0.35，P < 0.001）和治疗前肌酐浓度（斯皮尔曼相关系数ρ = 0.34，P < 0.001）均呈正相关，但接受载万古霉素骨水泥治疗的患者与未接受该治疗的患者之间无统计学显著差异。
在我们的PJI患者中，尽管遵循了当地和国家指南，但仍有很大比例的万古霉素谷浓度超出治疗范围。我们还可以确认，对于老年患者和肾功能受损患者需要谨慎用药。应进一步探索不需要如此广泛治疗药物监测的替代广谱抗生素。
