关键病患者中万科米辛度-时间曲线下的毒性和区域之间的关系:一个多中心的回顾性研究
Tomoyuki Ishigo1, Kazuaki Matsumoto2, Hiroaki Yoshida3
1Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan.
Microbiology spectrum
|May 22, 2024
概括
这项研究发现,在500-600μg·h/mL和600μg·h/mL以上的范科米辛 (VAN) 水平与重症监护室患者急性损伤 (AKI) 的风险较高有关. 优化VAN剂量对于患者安全至关重要.
科学领域:
- 药理学 药理学是指药理学的学科.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临界护理医学 临界护理医学
背景情况:
- 香草素 (Vancomycin,简称VAN) 对于治疗严重的甲素耐药黄金葡萄球菌感染至关重要.
- 升高的VAN度与急性损伤 (AKI) 的风险增加相关.
研究的目的:
- 在度-时间曲线 (AUC) 值下,评估AKI在不同万科米辛区域的发病率.
- 评估两点血液采集方法的有用性,以准确估计重症患者的AUC.
主要方法:
- 一个多中心的回顾性观察研究分析了146名接受VAN的重症监护病房患者.
- 患者根据AUC24-48h进行分组:<500,500-600和≥600μg·h/mL.
- 使用贝叶斯估计软件计算AUC值.
主要成果:
- 在AUC<500时,AKI率为6.5%,在AUC500-600时为28.0%,在AUC≥600μg·h/mL时为42.9%.
- 多变量分析显示AUC为500-600 (HR 5.4) 和≥600 (HR 7.0) 微克·小时/毫升,与<500微克·小时/毫升相比,AKI风险显著增加.
- 在第二天AUC和AKI风险之间发现了关联.
结论:
- 500-600μg·h/mL之间的万科米辛AUC,而不仅仅是>600μg·h/mL,在ICU患者中构成AKI的重大风险.
- 以AUC监测为指导的个性化万科米辛剂量,对于优化治疗和减轻AKI风险至关重要.
- 药剂师在优化VAN剂量方面发挥着关键作用,以实现治疗目标并改善患者的治疗结果.
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