治疗药物浓度监测下万古霉素治疗血流感染6例

发布时间：2018-06-22 19:40

本文选题：治疗药物浓度监测 + 血流感染　；参考：《中国感染与化疗杂志》2015年02期

【摘要】：目的探讨增大万古霉素剂量治疗血流感染的可行性。方法入选2013年7月1日—12月31日革兰阳性菌血流感染并使用万古霉素治疗的成人患者,检测万古霉素血药浓度并根据患者的治疗反应及血药浓度监测结果,调整万古霉素给药方案,同时记录患者的临床相关资料,分析治疗药物浓度监测下增大万古霉素剂量,治疗甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)血流感染患者的有效性及安全性。结果本研究中血流感染病原菌均为MRCNS,除1株人葡萄球菌的万古霉素MIC值为1 mg/L,其余菌株的万古霉素MIC值均为2 mg/L。常规剂量(2 g/d,或1.5 g/d)万古霉素的谷浓度平均值为(3.84±1.42)mg/L,高剂量(3 g/d)万古霉素谷浓度平均值为(9.13±4.88)mg/L。常规剂量时平均万古霉素曲线下面积(AUC)与MIC浓度比值(AUC/MIC)为152±39,高剂量用药时平均AUC/MIC为197±44。6例患者中有1例出现了肾功能损害。6例患者在使用万古霉素后3例临床和细菌学治愈,3例无效。结论万古霉素治疗肾功能正常的MRCNS血流感染患者时,建议在治疗药物浓度监测下调整患者个体化的给药方案,以达到目标治疗浓度。
[Abstract]:Objective to explore the feasibility of increasing vancomycin dosage in treating blood stream infection. Methods from July 1 to December 31, 2013, adult patients with Gram-positive bacterial blood flow infection and treated with vancomycin were selected. The blood concentration of vancomycin was detected and monitored according to the therapeutic response and blood concentration of vancomycin. To adjust the regimen of vancomycin administration, to record the clinical data of patients, and to analyze the increase of vancomycin dosage under the monitoring of therapeutic drug concentration. Efficacy and safety of methicillin-resistant coagulase-negative staphylococci (MRCNS) in blood stream infection. Results the pathogenic bacteria of blood flow infection were MRCNS.The MIC of vancomycin was 1 mg / L for one strain of staphylococcus and 2 mg / L for other strains. The average grain concentration of vancomycin was (3.84 卤1.42) mg / L in conventional dose (2 g / d, or 1.5 g / d) and (9.13 卤4.88) mg / L in high dose (3 g / d). The mean AUC to MIC concentration ratio (AUC / MIC) was 152 卤39 at conventional dose, and 1 out of 197 卤44.6 patients with high dose of vancomycin showed renal dysfunction in 3 patients after vancomycin administration. Bacteriological treatment was ineffective in 3 cases. Conclusion Vancomycin in the treatment of MRCNS with normal renal function suggests adjusting the individualized regimen to reach the target concentration.
【作者单位】：上海交通大学附属第一人民医院危重病科;上海交通大学附属第一人民医院检验科;复旦大学附属华山医院抗生素研究所;
【基金】：2010年度国家重点专科卫生部抗生素临床药理重点实验室建设项目
【分类号】：R96

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