Urine Vancomycin Level as a Method for Drug Monitoring in Patients With Normal and Decreased Kidney Function.
Urine Vancomycin Level as a Method for Drug Monitoring in Patients With Normal and Decreased Kidney Function.
复制标题
尿液万古霉素水平作为肾功能正常和下降患者药物监测的方法。
DOI：
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发表时间：
2017
影响因子：
1.3
通讯作者：
Mohammad M. Sajadi
中科院分区：
文献类型：
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作者：
S. Shokouhi;I. Alavi Darazam;Ziba Ayoubian;Mohammad M. Sajadi
介绍
万古霉素的治疗药物监测是临床决策和剂量调整中的一个重要问题，特别是对于病情危重和肾功能下降的患者。住院患者通常很容易获得尿液，与频繁的血液采样相比，尿液中的治疗药物监测可能是一种可靠且无创的程序。我们的目的是确定和验证尿液中万古霉素谷水平的诊断率。
材料和方法
在一项前瞻性研究中，95 名因任何临床病症接受万古霉素治疗的患者被纳入本研究。根据肾小球滤过率将患者分为两组（大于 80 mL/min/1.73 m2 与 15 mL/min/1.73 m2 至 80 mL/min/1.73 m2）。采用高压液相色谱法检测万古霉素血清谷浓度和同时尿谷浓度。
结果
万古霉素的平均血清和尿液谷浓度分别为13.13±1.34mg/L和7.79±1.23mg/L。血清和尿液谷值呈正线性相关（r = 0.38，P < .001），这在肾功能正常的患者中也显着（r = 0.43，P = .001）。估计的血清浓度等于尿万古霉素浓度加上5.3 mg/L。
结论
万古霉素尿液水平与同时血清水平相关，并且可以一致地预测肾功能正常患者的血清水平。因此，尿液万古霉素监测可作为血液采样的无创替代方案，特别是对于肾功能正常的患者。
INTRODUCTION
Therapeutic drug monitoring of vancomycin is an important issue in clinical decision-making and dosage modifying, particularly among patients in critical conditions and decreased kidney function. Urine is typically readily available in hospitalized patients and therapeutic drug monitoring in urine may be a reliable and noninvasive procedure compared to frequent blood sampling. We aimed to determine and validate the diagnostic yield of vancomycin trough level in urine.
MATERIALS AND METHODS
In a prospective study, 95 patients who were treated with vancomycin for any clinical condition were enrolled in this study. Patients were divided into 2 groups according to their glomerular filtration rate (greater than 80 mL/min/1.73 m2 versus 15 mL/min/1.73 m2 to 80 mL/min/1.73 m2). Vancomycin serum trough levels and simultaneous urine trough levels were detected by high-pressure liquid chromatography.
RESULTS
The mean serum and urine trough levels of vancomycin were 13.13 ± 1.34 mg/L and 7.79 ± 1.23 mg/L, respectively. The serum and urine trough levels had a positive linear correlation (r = 0.38, P < .001), which was also significant in patients with normal kidney function (r = 0.43, P = .001). The estimated serum concentration was equal to urine vancomycin concentration plus 5.3 mg/L.
CONCLUSIONS
Urine levels of vancomycin correlate with simultaneous serum levels and may consistently predict serum levels in patients with normal kidney function. Therefore, urine vancomycin monitoring might be used as a noninvasive alternative to blood sampling, particularly in patients with normal kidney function.