Vancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality.
Vancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality.
复制标题
DOI：
10.2147/tcrm.s266295
复制
发表时间：
2020
影响因子：
2.8
通讯作者：
Badri M
中科院分区：
文献类型：
--
作者：
Alshehri N;Ahmed AE;Yenugadhati N;Javad S;Al Sulaiman K;M Al-Dorzi H;Aljerasiy M;Badri M
万古霉素是最常见的治疗革兰氏阳性感染的药物之一，特别是在危重患者中。这项研究的目的是确定与三级重症监护病房(ICU)中万古霉素治疗低谷水平和死亡率相关的因素。这项回顾性研究评估了2017年10月1日至2018年12月31日期间住进利雅得阿卜杜勒阿齐兹国王医疗城的301名确诊为革兰阳性感染并接受静脉注射万古霉素的成年ICU患者。重度感染的万古霉素浓度为15-20 mg/L，轻度感染的万古霉素浓度为10-15 mg/L，被认为是有效的。患者年龄相对较大，平均年龄为60(SD±20)岁。初始万古霉素谷值为治疗性的168例(55.8%)。与万古霉素初始治疗低谷水平相关的因素有女性(调整后的优势比[AOR]=2.575)、高龄(AOR=1.024)、接受负荷剂量治疗(AOR=2.445)、有菌血症(AOR=2.061)和高血小板计数(AOR=1.003)。另一方面，估计肾小球滤过率(AOR=0.993)和白蛋白水平(AOR=0.944)的增加与初始治疗万古霉素谷值的几率较低有关。与较高死亡率相关的因素是女性(调整后的危险比[AHR]=2.630)、体重增加(AHR=1.021)、癌症(AHR=3.451)和APACHE II评分高(AHR=1.068)。这项研究确定了与达到万古霉素初始治疗低谷水平相关的几个因素(即年龄、女性、接受负荷剂量、菌血症、高血小板计数、低EGFR和白蛋白水平)。在对革兰氏阳性感染的危重患者使用万古霉素时，应考虑这些因素。
Vancomycin is one of the most common therapeutic agents for treating gram-positive infections, particularly in critically ill patients. The aim of this study was to identify factors associated with initial therapeutic vancomycin trough levels and mortality in a tertiary-care intensive care unit (ICU). This retrospective study evaluated 301 adult ICU patients admitted to King Abdulaziz Medical City in Riyadh between October 1, 2017 and December 31, 2018 with confirmed gram-positive infections and received intravenous vancomycin. Vancomycin trough levels of 15–20 mg/L for severe infections and 10–15 mg/L for less severe infections were considered therapeutic. The patients were relatively older with a mean age of 60 (SD ±20) years. Initial vancomycin trough levels were therapeutic in 168 (55.8%). Factors associated with initial therapeutic vancomycin trough levels were female gender (adjusted odds ratio [aOR]=2.575), older age (aOR=1.024), receiving a loading dose (aOR=2.445), having bacteremia (aOR=2.061), and high platelet count (aOR=1.003). On the other hand, the increase of estimated glomerular filtration rate (eGFR) (aOR=0.993) and albumin levels (aOR=0.944) were associated with lower odds of initial therapeutic vancomycin trough levels. Factors associated with higher mortality were female gender (adjusted hazard ratio [aHR]=2.630), increased body weight (aHR=1.021), cancer (aHR=3.451), and high APACHE II score (aHR=1.068). The study identified several factors associated with achieving initial therapeutic vancomycin trough levels (i.e. older age, female gender, receiving a loading dose, bacteremia, high platelets count, low eGFR and albumin level). These factors should be considered in the dosing of vancomycin in critically ill patients with gram-positive infections.