ASSOCIATION OF AMINOGLYCOSIDE PLASMA-LEVELS WITH THERAPEUTIC OUTCOME IN GRAM-NEGATIVE PNEUMONIA
ASSOCIATION OF AMINOGLYCOSIDE PLASMA-LEVELS WITH THERAPEUTIC OUTCOME IN GRAM-NEGATIVE PNEUMONIA
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DOI：
10.1016/0002-9343(84)90358-9
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发表时间：
1984-01-01
影响因子：
5.9
通讯作者：
LIETMAN, PS
中科院分区：
文献类型：
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作者：
MOORE, RD;SMITH, CR;LIETMAN, PS
为了确定血浆氨基糖苷水平与革兰氏阴性肺炎治疗结果的关系，我们分析了来自4项前瞻性、随机、对照庆大霉素、妥布霉素和阿米卡星试验的37例患者的病例报告。其中20例（54%）患者预后良好。患者输注后1小时最大（峰值）水平为7 .mu。G /ml或更高的庆大霉素和妥布霉素或28 .mu。g/ml或更高阿米卡星的患者（14 / 18,78%）比低于此水平的患者（6 / 19,32%）更常获得成功结局（P < 0.006）。患者总体平均峰值水平为6。G /ml或更高的庆大霉素和妥布霉素或24。g/ml或更高阿米卡星患者的成功结局（14 / 20,70%）高于低于此水平的患者（6 / 17,35%）（P < 0.04）。患者初始体温、血清尿素氮/肌酐比值、初始多形核白细胞计数和年龄也与预后相关；但通过多变量分析，达到适当的峰浓度是最重要的判别因素。这些结果提示在革兰氏阴性肺炎患者中达到足够的氨基糖苷水平的潜在重要性。
To determine the association of aminoglycoside plasma levels with therapeutic outcome in gram-negative pneumonia, the case reports of 37 patients from 4 prospective, randomized, controlled trials of gentamicin, tobramycin and amikacin were analyzed. Twenty (54%) of these patients had a favorable outcome. Patients with maximal 1-h postinfusion (peak) levels of 7 .mu.g/ml or greater for gentamicin and tobramycin or 28 .mu.g/ml or greater for amikacin more often had successful outcomes (14 of 18, 78%) than those with levels less than this (6 of 19, 32%) (P < 0.006). Patients with overall mean peak levels of 6 .mu.g/ml or greater for gentamicin and tobramycin or 24 .mu.g/ml or greater for amikacin more often had successful outcomes (14 of 20, 70%) than those with levels less than this (6 of 17, 35%) (P < 0.04). The initial patient temperature, serum urea nitrogen/creatinine ratio, initial polymorphonuclear leukocyte count, and age were also associated with outcome; but by multivariate analysis, achieving an adequate peak concentration was the most important discriminating factor. These results suggest the potential importance of achieving adequate aminoglycoside levels in patients with gram-negative pneumonia.