摘要
目的分析住院患者万古霉素血药浓度达标情况及影响因素,为万古霉素临床合理使用及治疗药物监测(TDM)开展提供参考。方法选取复旦大学附属中山医院2016年1月—2019年6月住院并接受万古霉素TDM的患者。收集病历资料,万古霉素血药浓度,急性肾损伤(AKI)发生情况等。根据药物浓度是否达标分组,使用Logistic回归分析药物浓度达标的影响因素。分析药物浓度与急性肾损伤发生的相关性。结果共纳入患者1106例。70.7%为男性,年龄中位数为60.0(IQR=20)岁。科室分布以外科为主,占比76.4%。万古霉素疗程中位天数为10.8(IQR=9.0)。仅有21.6%患者首次浓度监测为给药第4或5剂前。46.8%患者药物浓度监测结果在10~20μg·mL^(-1),达到目标浓度范围。万古霉素相关AKI发生率为25.9%。不同万古霉素药物浓度的患者AKI发生率不同:<10,10~<15,15~20,>20μg·mL^(-1)时,AKI发生率分别为15.8%、20.5%、25.8%和39.4%。多元Logistic回归分析显示:相比于用药疗程≤7 d,用药疗程>7~14 d(OR=1.688,P=0.001)以及用药疗程>14 d(OR=1.744,P=0.002)均更可能达到目标浓度。相比于接受非常规日剂量的患者,接受常规日剂量患者更可能达到目标浓度(OR=1.540,P=0.003)。结论我国万古霉素TDM现状依然存在监测时机延迟、目标浓度达标率低等不足。较高的万古霉素浓度与AKI显著相关,影响万古霉素浓度达标的因素主要包括用药疗程和用药方案的复杂性。
Objective To analyze the achievement of target vancomycin concentration and the risk factors affecting the concentration to reach the target,providing a reference for the rational use of vancomycin and the implementation of therapeutic drug monitoring(TDM).Methods Patients who were hospitalized and received vancomycin TDM from January 2016 to June 2019 at Zhongshan Hospital,Fudan University were selected.Clinical data,vancomycin blood concentrations,and occurrences of acute kidney injury(AKI)during the hospitalization were collected.Factors affecting the attainment of target vancomycin concentrations were analyzed using logistic regression and grouped according to whether the target concentrations were attained.The correlation between drug concentration and the occurrence of AKI was analyzed.Results A total of 1106 patients were included,with 70.7%being males and a median age of 60.0(IQR=20)years.Surgical departments accounted for 76.4%of the distribution.The median duration of vancomycin therapy was 10.8 d(IQR=9.0).A total of 21.6%of patients had their first concentration monitored before administration of doses 4 and 5.The drug concentration monitoring results of 46.8%(518/1106)of patients were in the range between 10-20μg·mL^(-1),reaching the target concentration range.The incidence of vancomycin-associated AKI was 25.9%.The incidence of AKI varied among patients with different vancomycin concentrations:when the concentrations are<10,10-<15,15-20,and>20μg·mL^(-1),the AKI rates are 15.8%,20.5%,25.8%,and 39.4%,respectively.Multivariate logistic regression analysis showed that target concentrations were more likely to be reached with a dosing course of>7-14 d(OR=1.688,P=0.001)and>14 d(OR=1.744,P=0.002)than with a dosing course of≤7 d.Patients receiving conventional daily doses were more likely to achieve target concentrations than those receiving the non-conventional daily dose(OR=1.540,P=0.003).Conclusion The current status of vancomycin TDM in China still suffers from deficiencies,such as delayed timing o
作者
潘坤明
李艳丽
徐辰祺
李然宜
许青
李晓宇
PAN Kunming;LI Yanli;XU Chenqi;LI Ranyi;XU Qing;LI Xiaoyu(Department of Pharmacy;Department of Nephrology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《医药导报》
北大核心
2024年第2期184-189,共6页
Herald of Medicine
基金
国家自然科学基金资助项目(82204520)
上海市卫生健康委员会(202240293)
中华国际医学交流基金(Z-2021-46-2101)
中国药学会(CPA-Z05-ZC-2021-002)
上海市药学会([2023]04)
上海市临床重点专科建设项目(shslczdzk06504)。
关键词
万古霉素
治疗药物监测
谷浓度
浓度达标
急性肾损伤
Vancomycin
Therapeutic drug monitoring
Trough concentration
Concentration attainment
Acute kidney injury
