万古霉素血清谷浓度监测对革兰阳性(G~+)球菌血流感染患者个体化用药方案的影响
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摘要
目的研究万古霉素血清谷浓度监测对革兰阳性(G+)球菌血流感染患者个体化用药方案的影响。方法选取该院2014年1月—2018年7月收治的G+球菌血流感染患者22例作为研究对象,均应用万古霉素治疗,并测定万古霉素血清谷浓度,分析临床疗效及肾毒性发生情况。结果经细菌培养可知,22例G+球菌血流感染患者中,屎肠球菌感染12例,占54.55%(12/22),耐甲氧西林金黄色葡萄球菌感染10例,占45.45%(10/22)。治疗后临床治愈率为31.82%(7/22),临床无效率为68.18%(15/22)。22例患者共监测万古霉素血清谷浓度33例次,其中达到靶浓度10～15μg/mL为12例次,占36.36%(12/33),两者万古霉素血清谷浓度分布情况相比,差异无统计学意义(P>0.05);临床治愈者万古霉素血清谷浓度与临床无效者比较,差异无统计学意义(t=0.607);临床治愈者肾毒性发生率0.00%(0/7)较临床无效者26.67%(4/15)低,但差异无统计学意义(P>0.05)。结论G~+球菌血流感染患者采取万古霉素血清谷浓度监测可为个体化用药方案提供信息支持,达到改善临床效果,降低肾毒性的目的。
Objective To study the effect of vancomycin serum trough concentration monitoring on individualized drug regimen in pa-tients with Gram-positive(G+) cocci infection. Methods 22 patients with G+cocci infection were enrolled in our hospital from January2014 to July 2018. All patients were treated with vancomycin. The serum concentration of vancomycin was measured to analyze the clinical efficacy and nephrotoxicity occurrance. Results According to bacterial culture, among the 22 patients with G+cocci infection,12 cases of enterococcus faecium infection accounted for 54.55%(12/22), and 10 cases of methicillin-resistant staphylococcus aureus infection, accounting for 45.45%(10/22). The clinical cure rate after treatment was 31.82%(7/22), and the clinical invalid rate was68.18%(15/22). A total of 33 cases of vancomycin serum trough concentration were monitored in 22 patients, of which 12 cases reached a target concentration of 10-15 μg/mL, accounting for 36.36%(12/33), and the distribution of vancomycin serum trough concentrations There was no statistically significant difference in the ratio(P>0.05). The serum concentration of vancomycin in clinically cured patients was not statistically significant(t=0.607). The incidence of nephrotoxicity in clinically cured patients was 0.00%(0/7)was lower than clinically ineffective patients 26.67%(4/15), but the difference was not statistically significant( P>0.05). Conclusion The monitoring of vancomycin serum trough concentration in patients with G~+ cocci blood flow infection can provide information sup-port for individualized drug use, and achieve the purpose of improving clinical effect and reducing nephrotoxicity.
Objective To study the effect of vancomycin serum trough concentration monitoring on individualized drug regimen in pa-tients with Gram-positive(G+) cocci infection. Methods 22 patients with G+cocci infection were enrolled in our hospital from January2014 to July 2018. All patients were treated with vancomycin. The serum concentration of vancomycin was measured to analyze the clinical efficacy and nephrotoxicity occurrance. Results According to bacterial culture, among the 22 patients with G+cocci infection,12 cases of enterococcus faecium infection accounted for 54.55%(12/22), and 10 cases of methicillin-resistant staphylococcus aureus infection, accounting for 45.45%(10/22). The clinical cure rate after treatment was 31.82%(7/22), and the clinical invalid rate was68.18%(15/22). A total of 33 cases of vancomycin serum trough concentration were monitored in 22 patients, of which 12 cases reached a target concentration of 10-15 μg/mL, accounting for 36.36%(12/33), and the distribution of vancomycin serum trough concentrations There was no statistically significant difference in the ratio(P>0.05). The serum concentration of vancomycin in clinically cured patients was not statistically significant(t=0.607). The incidence of nephrotoxicity in clinically cured patients was 0.00%(0/7)was lower than clinically ineffective patients 26.67%(4/15), but the difference was not statistically significant( P>0.05). Conclusion The monitoring of vancomycin serum trough concentration in patients with G~+ cocci blood flow infection can provide information sup-port for individualized drug use, and achieve the purpose of improving clinical effect and reducing nephrotoxicity.
引文
[1]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.
[2]刘坤贺,张春美.血清降钙素原对革兰阴性或革兰阳性菌血流感染的诊断价值[J].临床肺科杂志,2018,23(4):663-665.
[3]刘成,余美玲,许雅倩,等.国产与进口万古霉素在重症病人并发G~+球菌感染中的临床效果观察[J].蚌埠医学院学报,2018,43(8):31-34.
[4]王翠红,叶蕊,吴小街,等.万古霉素治疗革兰阳性球菌血流感染患者的血药浓度监测[J].实用药物与临床,2017,20(6):644-647.
[5]Mcneil JC,Kaplan SL,Vallejo JG.The Influence of the Route of Antibiotic Administration,Methicillin-Susceptibility,Vancomycin Duration and Serum Trough Concentration on Outcomes of Pediatric Staphylococcus aureus Bacteremic Osteoarticular Infection[J].Pediatr Infect Dis J,2017,36(6):572-577.
[6]刘明涛,常刚,李凯述,等.万古霉素分别联合三种抗菌药物对异质性万古霉素中介金黄色葡萄球菌耐药突变选择窗的影响[J].中华医院感染学杂志,2017,27(14):3147-3149.
[7]李媛媛,张光莉,田小银,等.革兰阳性球菌重症肺炎患儿万古霉素血药谷浓度影响因素分析[J].临床儿科杂志,2017,35(6):421-424.
[8]Hos N J,Jazmati N,Stefanik D,et al.Determining vancomycin Etest MICs in patients with MRSA bloodstream infection does not support switching antimicrobials[J].J Infect,2017,74(3):248-259.
[9]张慧芳,王瑞兰,舒文,等.成人患者万古霉素血药浓度监测及有效性和安全性评估[J].中华危重病急救医学,2018,30(6):538.
[10]林宗钦,江智毅,陈娟,等.重症患者万古霉素血清谷浓度监测的临床研究[J].中华危重病急救医学,2014,26(7):473-477.
[11]王欣怡,张忠银.用蒙特卡洛模拟优化耐甲氧西林金黄色葡萄球菌感染的肾功能不全低龄患儿万古霉素的给药方案[J].安徽医药,2017,21(11):2057-2061.
[12]王翠红,栾婷,叶蕊,等.万古霉素血清谷浓度监测及临床应用分析[J].中国临床药理学杂志,2017,33(9):771-773.
[2]刘坤贺,张春美.血清降钙素原对革兰阴性或革兰阳性菌血流感染的诊断价值[J].临床肺科杂志,2018,23(4):663-665.
[3]刘成,余美玲,许雅倩,等.国产与进口万古霉素在重症病人并发G~+球菌感染中的临床效果观察[J].蚌埠医学院学报,2018,43(8):31-34.
[4]王翠红,叶蕊,吴小街,等.万古霉素治疗革兰阳性球菌血流感染患者的血药浓度监测[J].实用药物与临床,2017,20(6):644-647.
[5]Mcneil JC,Kaplan SL,Vallejo JG.The Influence of the Route of Antibiotic Administration,Methicillin-Susceptibility,Vancomycin Duration and Serum Trough Concentration on Outcomes of Pediatric Staphylococcus aureus Bacteremic Osteoarticular Infection[J].Pediatr Infect Dis J,2017,36(6):572-577.
[6]刘明涛,常刚,李凯述,等.万古霉素分别联合三种抗菌药物对异质性万古霉素中介金黄色葡萄球菌耐药突变选择窗的影响[J].中华医院感染学杂志,2017,27(14):3147-3149.
[7]李媛媛,张光莉,田小银,等.革兰阳性球菌重症肺炎患儿万古霉素血药谷浓度影响因素分析[J].临床儿科杂志,2017,35(6):421-424.
[8]Hos N J,Jazmati N,Stefanik D,et al.Determining vancomycin Etest MICs in patients with MRSA bloodstream infection does not support switching antimicrobials[J].J Infect,2017,74(3):248-259.
[9]张慧芳,王瑞兰,舒文,等.成人患者万古霉素血药浓度监测及有效性和安全性评估[J].中华危重病急救医学,2018,30(6):538.
[10]林宗钦,江智毅,陈娟,等.重症患者万古霉素血清谷浓度监测的临床研究[J].中华危重病急救医学,2014,26(7):473-477.
[11]王欣怡,张忠银.用蒙特卡洛模拟优化耐甲氧西林金黄色葡萄球菌感染的肾功能不全低龄患儿万古霉素的给药方案[J].安徽医药,2017,21(11):2057-2061.
[12]王翠红,栾婷,叶蕊,等.万古霉素血清谷浓度监测及临床应用分析[J].中国临床药理学杂志,2017,33(9):771-773.