重症患者管饲万古霉素后其血清谷浓度监测及影响因素
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摘要
目的研究耐甲氧西林金黄色葡萄球菌(MRSA)肠炎或伪膜性肠炎重症患者管饲万古霉素后期血清谷浓度范围及变化,分析患者病情严重程度和肾功能等因素对管饲万古霉素的血清谷浓度水平的影响。方法收集2017年1月31日至2018年1月31日于重症监护室(ICU)住院治疗的12例MRSA或伪膜性肠炎并管饲万古霉素患者的临床资料,进行回顾性分析。结果最终纳入10例患者,20次血清谷浓度监测结果,其中85%的血清谷浓度<5 mg·L~(-1)。性别、年龄、疾病严重程度、连续肾脏替代疗法(CRRT)、初始剂量和肾功能对患者万古霉素血清谷浓度的影响均无统计学意义(P>0.05)。结论管饲万古霉素治疗MRSA肠炎或伪膜性肠炎,生物利用度低,需要警惕因肠道黏膜损坏导致的万古霉素的全身吸收。患者基础状况对管饲万古霉素血清谷浓度无较大影响。随着病情好转,万古霉素血清谷浓度逐渐下降。
AIM To study the range and variation of trough level of vancomycin administered via feeding tube in critical ill patients with methicillin-resistant Staphylococcus(MRSA) or Pseudomembranous enteritis, and to assess the effects of disease severity and renal function on the serum concentration of vancomycin. METHODS Retrospective analysis was carried out in intensive care unit(ICU) including 12 patients with MRSA or Pseudomem-branous enteritis, from January 31, 2017 to January 31, 2018. RESULTS The 20 vancomycin trough levels from 10 patients were included, with 85% of the readings less than 5 mg·L~(-1). No statistically significant difference was found in vancomycin trough level among patients of different gender, age, severity of disease,continuous renal replacement therapy(CRRT), initial dose and renal function. CONCLUSION Despite the low bioavailability of vankncomycin via feeding tube,cautions should still be taken in case of systemic absorption due to intestinal mucus damage.Patients' baseline disease status was not associated significantly with vancomycin trough level. However, as disease status improved, vancomycin concentration shows the trend to decrease gradually.
AIM To study the range and variation of trough level of vancomycin administered via feeding tube in critical ill patients with methicillin-resistant Staphylococcus(MRSA) or Pseudomembranous enteritis, and to assess the effects of disease severity and renal function on the serum concentration of vancomycin. METHODS Retrospective analysis was carried out in intensive care unit(ICU) including 12 patients with MRSA or Pseudomem-branous enteritis, from January 31, 2017 to January 31, 2018. RESULTS The 20 vancomycin trough levels from 10 patients were included, with 85% of the readings less than 5 mg·L~(-1). No statistically significant difference was found in vancomycin trough level among patients of different gender, age, severity of disease,continuous renal replacement therapy(CRRT), initial dose and renal function. CONCLUSION Despite the low bioavailability of vankncomycin via feeding tube,cautions should still be taken in case of systemic absorption due to intestinal mucus damage.Patients' baseline disease status was not associated significantly with vancomycin trough level. However, as disease status improved, vancomycin concentration shows the trend to decrease gradually.
引文
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[3] 韦瑶,龚剑锋,郭栋,等.粪便菌群移植联合万古霉素治疗小肠造口术后耐甲氧西林金黄色葡萄球菌肠炎1例报告[J].中国实用外科杂志,2014,34(6):584.
[4] RODRIGUEZ C,Van BROECK J,TAMINIAU B,et al.Clostridium difficile infection:early history,diagnosis and molecular strain typing methods[J].Microb Pathog,2016,97:59.
[5] HAWKEY P M,MARRIOTT C,LIU W E,et al.Molecular epidemiology of clostridium difficile infection in a major chinese hospital:an underrecognized problem in Asia?[J].J Clin Microbiol,2013,51(10):3308.
[6] BASSETTI M,VILLA G,PECORI D,et al.Epidemiology,diagnosis and treatment of clostridium difficile infection[J].Expert Rev Anti Infect Ther,2012,10(12):1405.
[7] GILBERT D N,CHAMBERS H F,ELIOPOULOS G M,et al.The Sanford guide to anitimicrobial therapy[M].Beijing:Peking Union Medical College Press,2016:17-18.
[8] SARTELLI M,MALANGONI M A,ABU-ZIDAN F M,et al.WSES guidelines for management of clostridium difficile infection in surgical patients[J].World J Emerg Surg,2015,10(38):1.
[9] VANCOCIN(vancomycin HCl) oral capsules[S].Viro Pharma Incorporated (per FDA),Exton,PA,2011.
[10] YAMAZAKI S,SUZUKI T,SUZUKI T,et al.An extremely high bioavailability of orally administered vancomycin in a patient with severe colitis and renal insufficiency[J].J Infect Chemother,2017,23(12):848.
[11] CHIHARA S,SHIMIZU R,FURUKATA S,et al.Oral vancomycin may have significant absorption in patients with Clostridium difficile colitis[J].Scand J Infect Dis,2011,43(2):149.
[12] PETTIT N N,DEPESTEL D D,FOHL A L,et al.Risk factors for systemic vancomycin exposure following administration of oral vancomycin for the treatment of clostridium difficile infection[J].Pharmacotherapy,2015,35(2):119 .
[13] FEKETY R,SILVA J,KAUFFMAN C,et al.Treatment of antibiotic-associated clostridium difficile colitis with oral vancomycin:comparison of two dosage regimens[J].Am J Med,1989,86(1):15.
[14] ARMSTRONG C J,WILSON T S.Systemic absorption of vancomycin[J].J Clin Pathol,1995,48(7):689.