New Regimen for Continuous Infusion of Vancomycin in Critically Ill Patients
New Regimen for Continuous Infusion of Vancomycin in Critically Ill Patients
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DOI：
10.1128/aac.00330-16
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发表时间：
2016-08-01
影响因子：
4.9
通讯作者：
Taccone, Fabio Silvio
中科院分区：
文献类型：
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作者：
Cristallini, Stefano;Hites, Maya;Taccone, Fabio Silvio
尽管开发了具有抗革兰氏阳性细菌活性的新药物，万古霉素仍然是危重脓毒症患者的主要抗生素之一。由于脓毒症可以改变抗菌药物的药代动力学，因此制定适当的给药策略以提供足够的浓度至关重要。本研究的目的是前瞻性验证万古霉素持续输注（CI）给脓毒症患者的新给药方案。我们纳入了2012年1月至2013年5月期间入住混合重症监护病房（ICU）的所有成年脓毒症患者，他们接受了一种新的万古霉素CI治疗方案，该方案包括负荷剂量为35 mg/kg体重，作为4小时输注，随后每日CI剂量适应肌酐清除率（CrCL），根据Cockcroft-Gault公式估计（中位剂量为2,112[1,500至2,838]mg）。在给药结束（T1）、12 h （T2）、24 h （T3）和治疗开始后第1天（T4）测定万古霉素浓度。万古霉素在T2、T3和T4的浓度为20 - 30mg /l被认为是足够的。共纳入107例患者（72%为男性）。中位年龄、体重和CrCL分别为59（四分位数范围[IQR]， 48至71）岁、75 (IQR， 65至85)kg和94 (IQR， 56至140)ml/min。T1、T2、T3和T4时万古霉素浓度分别为44 （IQR, 37 ~ 49）、25 （IQR, 21 ~ 32）、22 （IQR, 19 ~ 28）和26 (IQR, 22 ~ 29) mg/l。56%（60/107）的患者在T2、54%（57/105）的患者在T3和73%（41/56）的患者在T4时浓度足够。这种万古霉素治疗方案允许大多数患者快速达到血清中的目标浓度。在治疗12小时时，只有16%的患者浓度不足。
Despite the development of new agents with activity against Gram-positive bacteria, vancomycin remains one of the primary antibiotics for critically ill septic patients. Because sepsis can alter antimicrobial pharmacokinetics, the development of an appropriate dosing strategy to provide adequate concentrations is crucial. The aim of this study was to prospectively validate a new dosing regimen of vancomycin given by continuous infusion (CI) to septic patients. We included all adult septic patients admitted to a mixed intensive care unit (ICU) between January 2012 and May 2013, who were treated with a new vancomycin CI regimen consisting of a loading dose of 35 mg/kg of body weight given as a 4-h infusion, followed by a daily CI dose adapted to creatinine clearance (CrCL), as estimated by the Cockcroft-Gault formula (median dose, 2,112 [1,500 to 2,838] mg). Vancomycin concentrations were measured at the end of the loading dose (T1), at 12 h (T2), at 24 h (T3), and the day after the start of therapy (T4). Vancomycin concentrations of 20 to 30 mg/liter at T2, T3, and T4 were considered adequate. A total of 107 patients (72% male) were included. Median age, weight, and CrCL were 59 (interquartile range [IQR], 48 to 71) years, 75 (IQR, 65 to 85) kg, and 94 (IQR, 56 to 140) ml/min, respectively. Vancomycin concentrations were 44 (IQR, 37 to 49), 25 (IQR, 21 to 32), 22 (IQR, 19 to 28), and 26 (IQR, 22 to 29) mg/liter at T1, T2, T3, and T4, respectively. Concentrations were adequate in 56% (60/107) of patients at T2, in 54% (57/105) at T3, and in 73% (41/56) at T4. This vancomycin regimen permitted rapid attainment of target concentrations in serum for most patients. Concentrations were insufficient in only 16% of patients at 12 h of treatment.