万古霉素的临床应用及急性肾损伤监测现状分析
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摘要
目的分析万古霉素在中国部分地区的使用情况和万古霉素导致急性肾损伤的监测情况。方法用问卷调查、数据检索和文献检索的方式收集全国各地医院使用万古霉素、万古霉素治疗药物监测(TDM)和血清肌酸酐(SCr)监测的情况,并用Excel对数据进行统计分析。结果万古霉素用药情况调查包含北京、成都、广州、杭州、上海、天津、郑州和沈阳8个地区103家医疗机构的万古霉素、替考拉宁及利奈唑胺使用情况。万古霉素在临床使用比例为31.4%～94.4%,且在一些地区有上升的趋势。万古霉素TDM监测情况调查包括全国29个省市共214家医疗机构,三级医院均进行万古霉素的TDM调查。用万古霉素患者SCr监测情况的研究中,初步纳入中英文文献共37篇,其中大部分研究中都在用药前后进行SCr检测,但检测时间各不相同。结论中国万古霉素TDM监测手段已较为成熟,部分医疗机构已在用药前后对患者的SCr进行监测,但监测时机、监测对象等还不够规范,因此规范中国万古霉素使用指南和采用信息系统软件强制性实施SCr和TDM的规范监测等都是万古霉素合理使用的有效手段。
Objective To make a investigation in parts of China about vancomycin using and vancomycin induced acute kidney injury.Methods Using questionnaire survey and literature research to collect the data of vancomycin usage in hospitals,therapeutic drug monitoring(TDM) situation and serum creatinine(SCr) monitoring,then use Excel to analyze data.Results Vancomycin drug investigation include 103 medical institutions from Beijing,Chengdu,Guangzhou,Hangzhou,Shanghai,Tianjin,Zhengzhou and Shenyang.The proportion of vancomycin in clinical use was 31.4%-94.4%,and there was an upward trend in some areas.The investigation of vancomycin TDM include 214 medical institutions from 29 provinces.Most hospitals,especially tertiary hospitals,conducted vancomycin TDM.The reference searching study of vancomycin SCr monitoring contains 37 references in English and Chinese.Most of them detection SCr before and after drug using,but almost at different time.Conclusion Vancomycin TDM monitoring method has been relatively mature in China.Part of the hospitals has been used to monitor the patient's SCr,but the monitoring time,monitoring objects are still not normative.Therefore, normative vancomycin guidelines and useing software or information systems to achieve mandatory implementation of SCr and TDM are reasonable ways.
Objective To make a investigation in parts of China about vancomycin using and vancomycin induced acute kidney injury.Methods Using questionnaire survey and literature research to collect the data of vancomycin usage in hospitals,therapeutic drug monitoring(TDM) situation and serum creatinine(SCr) monitoring,then use Excel to analyze data.Results Vancomycin drug investigation include 103 medical institutions from Beijing,Chengdu,Guangzhou,Hangzhou,Shanghai,Tianjin,Zhengzhou and Shenyang.The proportion of vancomycin in clinical use was 31.4%-94.4%,and there was an upward trend in some areas.The investigation of vancomycin TDM include 214 medical institutions from 29 provinces.Most hospitals,especially tertiary hospitals,conducted vancomycin TDM.The reference searching study of vancomycin SCr monitoring contains 37 references in English and Chinese.Most of them detection SCr before and after drug using,but almost at different time.Conclusion Vancomycin TDM monitoring method has been relatively mature in China.Part of the hospitals has been used to monitor the patient's SCr,but the monitoring time,monitoring objects are still not normative.Therefore, normative vancomycin guidelines and useing software or information systems to achieve mandatory implementation of SCr and TDM are reasonable ways.
引文
[1]RYBAK M,LOMAESTRO B,ROTSCHAFER J C,et al.Therapeutic monitoring of vancomycin in adult patients:A consensus review of the American Society of Health-System Pharmacists,the Infectious Diseases Society of America,and the Society of Infectious Diseases Pharmacists[J].Am J Health Syst Pharm,2009,66(1):82-98.
[2]ELYASI S,KHALILI H,DASHTI-KHAVIDAKI S,et al.Vancomycin-induced nephrotoxicity:Mechanism,incidence,risk factors and special populations.A literature review[J].Eur J Clin Pharmacol,2012,68(9):1243-1255.
[3]MERGENHAGEN K A,BORTON A R.Vancomycin nephrotoxicity:a review[J].J Pharm Pract,2014,27(6):545-553.
[4]李雪,赵文静,臧宝赫,等.万古霉素2种不同静脉给药方案的疗效及肾毒性的分析[J].中国现代医学杂志,2017,27(7):85-89.
[5]张海燕,朱春香,罗万慰,等.万古霉素相关急性肾损伤的危险因素分析[J].中国医院药学杂志,2016,36(6):503-507.
[6]张慧芳,汤荣,舒文,等.治疗药物浓度监测下万古霉素治疗血流感染6例[J].中国感染与化疗杂志,2015,15(2):149-154.
[7]李昕,李焕德,徐兵,等.万古霉素治疗细菌性肺炎患者时血药谷浓度与肾毒性相关性研究[J].中南药学,2009,7(5):352-356.
[8]郑治渊,郑安琳,朱华,等.高龄老人严重感染应用万古霉素治疗的安全性研究[J].老年医学与保健,2004,10(4):237-239.
[9]陈春燕,朱素燕,周科挺,等.万古霉素谷浓度预测重症肺炎疗效及肾毒性的回顾性分析[J].中国现代应用药学,2016,33(9):1188-1194.
[10]LODISE T P,PATEL N,LOMAESTRO B M,et al.Relationship between initial vancomycin concentration-time profile and nephrotocicity among hospitalized patients[J].Clin Infect Dis,2009,49(4):507-514.
[11]LODISE T P,LOMAESTRO B,GRAVES J,et al.Larger vancomycin doses(at least four grams per day)are associated with an increased incidence of nephrotoxicity[J].Antimicrob Agents Chemother,2008,52(4):1330-1336.
[12]BONAZZA S,BRESEE L C,KRAFT T,et al.Frequency of and risk factors for acute kidney injury associated with vancomycin use in the pediatric intensive care unit[J].J Pediatr Pharmacol Ther,2016,21(6):486-493.
[13]O’DONNELL J N,GHOSSEIN C,RHODES N J,et al.Eight unexpected cases of vancomycin associated acute kidney injury with contemporary dosing[J].J Infect Chemother,2017,23(5):326-332.
[14]ZASOWSKI E J,MURRAY K P,TRINH T D,et al.Identification of vancomycin exposure-toxicity thresholds in hospitalized patients receiving intravenous vancomycin[J/OL].Antimicrob Agents Chemother,2017,62(1):e01684-17.2017-12-17[2019-03-10].http://aac.asm.org/cgi/pmidlookup?view=long&pmid=29084753.
[15]FOWLER VG J R,BOUCHER H W,COREY G R,et al.Daptomycin versus standard therapy for vacteremia and endocarditis caused by Staphylococcus aureus[J].N Engl J Med,2006,355(7):653-665.
[16]WILCOX M H,COREY G R,TALBOT G H,et al.CANVAS 2:the second phaseⅢ,randomized,double-blind study evaluating ceftaroline fosamil for the treatment of patients with complicated skin and skin structure infections[J].J Antimicrob Chemother,2010,65(4):53-65.
[17]COREY G R,WILCOX M,TALBOT G H,et al.Integrated analysis of CANVAS 1 and 2:phase 3,multicenter,randomized,double-blind studies to evaluate the safety and efficacy of ceftaroline versus vancomycin plus aztreonam in complicated skin and skinstrcture infection[J].Clin Ifect Dis,2010,51(6):641-650.
[18]CARRENO J J,KENNEY R M,DIVINE G,et al.Randomized controlled trial to determine the efficacy of early switch from vancomycin to vancomycin alternatives as a strategy to prevent nephrotoxicity in patients with multiple risk factors for adverse renal outcomes(STOP-NT)[J].Ann Pharmacother,2017,51(3):185-193.
[19]RUTTER W C,BURGESS D R,TALBERT J C,et al.Acute kidney injury in patients treated with vancomycin and piperacillintazobactam:A retrospective cohort analysis[J].J Hosp Med,2017,12(2):77-82.
[20]WUNDERINK R G,NIEDERMAN M S,KOLLEF M H,et al.Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia:a randomized,controlled study[J].Clin Infect Dis,2012,54(5):621-629.
[21]PAN K M,WU Y,CHEN C,et al.Vancomycin-induced acute kidney injury in elderly Chinese patients:a single center crosssection study[J].Br J Clin Pharmacol,2018,84(8):1706-1718.
[22]CHACKUPURAKAL R,REESSING J,WAPPLER F,et al.Predictors of acute kidney injury under continuous infusion of vancomycin in critically ill surgical patient[J].Intensive Care Medicine Experimental,2015,3(1):A637.
[23]PATEL N,PAI M P,RODVOLD K A,et al.Vancomycin:we can’t get there from here[J].Clin Infect Dis,2011,52(8):969-974.
[24]COREY G R,WILCOX M H,TALBOT G H,et al.CANVAS 1:the first phaseⅢ,randomized,double-blind study evaluating ceftaroline fosamil for the treatment of patients with complicated skin and skin structure infections[J].J Antimicrob Chemother,2010,65(4):53-65.
[2]ELYASI S,KHALILI H,DASHTI-KHAVIDAKI S,et al.Vancomycin-induced nephrotoxicity:Mechanism,incidence,risk factors and special populations.A literature review[J].Eur J Clin Pharmacol,2012,68(9):1243-1255.
[3]MERGENHAGEN K A,BORTON A R.Vancomycin nephrotoxicity:a review[J].J Pharm Pract,2014,27(6):545-553.
[4]李雪,赵文静,臧宝赫,等.万古霉素2种不同静脉给药方案的疗效及肾毒性的分析[J].中国现代医学杂志,2017,27(7):85-89.
[5]张海燕,朱春香,罗万慰,等.万古霉素相关急性肾损伤的危险因素分析[J].中国医院药学杂志,2016,36(6):503-507.
[6]张慧芳,汤荣,舒文,等.治疗药物浓度监测下万古霉素治疗血流感染6例[J].中国感染与化疗杂志,2015,15(2):149-154.
[7]李昕,李焕德,徐兵,等.万古霉素治疗细菌性肺炎患者时血药谷浓度与肾毒性相关性研究[J].中南药学,2009,7(5):352-356.
[8]郑治渊,郑安琳,朱华,等.高龄老人严重感染应用万古霉素治疗的安全性研究[J].老年医学与保健,2004,10(4):237-239.
[9]陈春燕,朱素燕,周科挺,等.万古霉素谷浓度预测重症肺炎疗效及肾毒性的回顾性分析[J].中国现代应用药学,2016,33(9):1188-1194.
[10]LODISE T P,PATEL N,LOMAESTRO B M,et al.Relationship between initial vancomycin concentration-time profile and nephrotocicity among hospitalized patients[J].Clin Infect Dis,2009,49(4):507-514.
[11]LODISE T P,LOMAESTRO B,GRAVES J,et al.Larger vancomycin doses(at least four grams per day)are associated with an increased incidence of nephrotoxicity[J].Antimicrob Agents Chemother,2008,52(4):1330-1336.
[12]BONAZZA S,BRESEE L C,KRAFT T,et al.Frequency of and risk factors for acute kidney injury associated with vancomycin use in the pediatric intensive care unit[J].J Pediatr Pharmacol Ther,2016,21(6):486-493.
[13]O’DONNELL J N,GHOSSEIN C,RHODES N J,et al.Eight unexpected cases of vancomycin associated acute kidney injury with contemporary dosing[J].J Infect Chemother,2017,23(5):326-332.
[14]ZASOWSKI E J,MURRAY K P,TRINH T D,et al.Identification of vancomycin exposure-toxicity thresholds in hospitalized patients receiving intravenous vancomycin[J/OL].Antimicrob Agents Chemother,2017,62(1):e01684-17.2017-12-17[2019-03-10].http://aac.asm.org/cgi/pmidlookup?view=long&pmid=29084753.
[15]FOWLER VG J R,BOUCHER H W,COREY G R,et al.Daptomycin versus standard therapy for vacteremia and endocarditis caused by Staphylococcus aureus[J].N Engl J Med,2006,355(7):653-665.
[16]WILCOX M H,COREY G R,TALBOT G H,et al.CANVAS 2:the second phaseⅢ,randomized,double-blind study evaluating ceftaroline fosamil for the treatment of patients with complicated skin and skin structure infections[J].J Antimicrob Chemother,2010,65(4):53-65.
[17]COREY G R,WILCOX M,TALBOT G H,et al.Integrated analysis of CANVAS 1 and 2:phase 3,multicenter,randomized,double-blind studies to evaluate the safety and efficacy of ceftaroline versus vancomycin plus aztreonam in complicated skin and skinstrcture infection[J].Clin Ifect Dis,2010,51(6):641-650.
[18]CARRENO J J,KENNEY R M,DIVINE G,et al.Randomized controlled trial to determine the efficacy of early switch from vancomycin to vancomycin alternatives as a strategy to prevent nephrotoxicity in patients with multiple risk factors for adverse renal outcomes(STOP-NT)[J].Ann Pharmacother,2017,51(3):185-193.
[19]RUTTER W C,BURGESS D R,TALBERT J C,et al.Acute kidney injury in patients treated with vancomycin and piperacillintazobactam:A retrospective cohort analysis[J].J Hosp Med,2017,12(2):77-82.
[20]WUNDERINK R G,NIEDERMAN M S,KOLLEF M H,et al.Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia:a randomized,controlled study[J].Clin Infect Dis,2012,54(5):621-629.
[21]PAN K M,WU Y,CHEN C,et al.Vancomycin-induced acute kidney injury in elderly Chinese patients:a single center crosssection study[J].Br J Clin Pharmacol,2018,84(8):1706-1718.
[22]CHACKUPURAKAL R,REESSING J,WAPPLER F,et al.Predictors of acute kidney injury under continuous infusion of vancomycin in critically ill surgical patient[J].Intensive Care Medicine Experimental,2015,3(1):A637.
[23]PATEL N,PAI M P,RODVOLD K A,et al.Vancomycin:we can’t get there from here[J].Clin Infect Dis,2011,52(8):969-974.
[24]COREY G R,WILCOX M H,TALBOT G H,et al.CANVAS 1:the first phaseⅢ,randomized,double-blind study evaluating ceftaroline fosamil for the treatment of patients with complicated skin and skin structure infections[J].J Antimicrob Chemother,2010,65(4):53-65.