摘要
目的了解万古霉素血药浓度在革兰阳性菌感染患者疗效评估中的作用及安全性。方法收集2016年3月至2017年10月63例住院患者万古霉素血药浓度监测结果,对照病案资料,探讨万古霉素血药浓度、最低抑菌浓度(MIC)及不良反应情况。结果 63例患者血药谷浓度10～20 mg/L有26例(41. 3%),<10 mg/L有29例(46. 0%),> 20 mg/L有8例(12. 7%)。按年龄组分层统计,17～60岁组,血药浓度<10 mg/L为19例(54. 3%),10～20 mg/L为13例(37. 1%),20 mg/L为3例(8. 6%);61～90岁组,血药浓度<10 mg/L为10例(35. 7%),10～20 mg/L为13例(46. 4%),> 20 mg/L为5例(17. 9%)。11株金黄色葡萄球菌中检出耐甲氧西林金黄色葡萄球菌(MRSA)7株。培养分离出包括表皮葡萄球菌、溶血葡萄球菌等凝固酶阴性葡萄球菌总共11株,其中耐甲氧西林凝固酶阴性葡萄球菌(MRSCON)9株。药敏试验显示,万古霉素对30株(78. 9%)革兰阳性菌MIC <1. 0μg/ml,检出8例(21. 1%) MIC为1. 0～2. 0μg/ml。单用万古霉素治疗15例(23. 8%),联用一种抗菌药物40例(63. 5%),联用两种及以上抗菌药物8例(12. 7%)。17～60岁组和61～90岁组患者万古霉素用药前后血液尿素和肌酐水平比较无统计学差异(P> 0. 05)。结论依据病原菌及药敏试验结果,监测万古霉素血药浓度,适时调整药物剂量,有利于提高疗效、降低毒性,实现合理用药。
Abstruction： Objective To comprehend the role and safety of vancomycin blood concentration in the evaluation of the efficacy of Gram-positive bacterial infection. Methods Vancomycin therapeutic drug monitoring results of 63 hospitalized patients from March 2016 to October 2017 were collected,the blood vancomycin concentration,minimum inhibitory concentration（MIC） and adverse reactions were investigated by comparing the medical records. Results In the 63 patients,there were 26 cases（41. 3%） with minimum plasma concentration（Cmin） ranging from 10 to 20 mg/L,29 cases（46. 0%） with Cmin 〈10 mg/L and 8 cases（12. 7%） with Cmin 〉20 mg/L. According to the age group,there were 19 cases（54. 3%） with Cmin 〈10 mg/L,13 cases（37. 1%） with Cminranging from 10 to 20 mg/L,and 3 cases（8. 6%） with Cmin 〉20 mg/L in 17-60 years old group,and there were 10 cases（35. 7%） with Cmin 〈10 mg/L,13 cases（46. 4%） with Cminranging from 10 to 20 mg/L,and 5 cases（17. 9%） with Cmin 〉20 mg/L in 61-90 years old group. There were 7 strains were identified as Methicillin-resistant Staphylococcus aureus（MRSA） in 11 Staphylococcus aureus strains. A total of 11 coagulase-negative staphylococci including Staphylococcus epidermidis and Staphylococcus haemolyticus were isolated,of which 9 strains were methicillin-resistant coagulase-negative staphylococci（MRSCON）. Antimicrobial susceptibility test showed that MIC of vancomycin against 30 strains（78. 9%） of Gram-positive bacteria was less than 1. 0μg/ml,and 8 strains（21. 1%） of vancomycin were detected to be 1. 0 to 2. 0 μg/ml. There were 15 cases（23. 8%）treated with vancomycin alone,40 cases（63. 5%） treated with vancomycin combined with one antibiotic and 8 cases（12. 7%） treated with vancomycin combined with two or more antibiotics. There were no significant differences in serum urea and creatinine levels between 17-60 years old group and 61-90 years old group before and after vancomycintreatment（all P〉0. 05）. Conc
作者
陈翠红
姬文莉
童华诚
CHEN Cui-hong;JI Wen-li;TONG Hua-cheng(Department of Pharmacy,Nanjing Tongren Hospital Affiliated to Medical School of Southeast University,Nanjing,Jiangsu 211102,China)
出处
《中国临床研究》
CAS
2018年第11期1574-1577,共4页
Chinese Journal of Clinical Research
关键词
万古霉素
血药浓度
革兰阳性菌
最低抑菌浓度
合理用药
肾功能
Vancomycin
Blood concentration
Gram-positive bacterium
Minimum inhibitory concentration
Rational use of medicines
Renal function
