治疗药物浓度监测下万古霉素治疗血流感染6例  

Report of 6 cases of vancomycin-treated blood stream infection under therapeutic drug monitoring

作　　者：张慧芳[1] 汤荣[2] 舒文[2] 王瑞兰[1] 梁晓宇[3] 杨洋[3] 吴菊芳[3] 张菁[3] 

机构地区：[1]上海交通大学附属第一人民医院危重病科,上海201620 [2]上海交通大学附属第一人民医院检验科,上海201620 [3]复旦大学附属华山医院抗生素研究所

出　　处：《中国感染与化疗杂志》2015年第2期149-154,共6页Chinese Journal of Infection and Chemotherapy

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

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。Objective This report aims to explore the outcome of blood stream infection following high dose vancomycin treatment under therapeutic drug monitoring.Methods This is an observational research.The patients satisfying the following criteria were included from July 1,2013 to December 31,2013：18-65 years of age;non-neutropenic with normal renal function;confirmed blood stream infection due to gram-positive bacteria;at least one observation of serum vancomycin concentration.Vancomycin dose was adjusted according to patient′s clinical response and serum vancomycin concentration.Results All the pathogens isolated from blood stream were meticillin-resistant coagulase-negative Staphylococcus（MRCNS）.The minimum inhibitory concentration（MIC）of vancomycin was 2 mg/L,except one strain of Staphylococcus hominis（1 mg/L）.The mean serum concentration of vancomycin was 3.84± 1.42 mg/L following standard therapy（1 g,q12 h or 0.5 g,q8h）,and 9.13 ± 4.88 mg/L following high dose therapy.The mean ratio of area under curve and minimum inhibitory concentration（AUC/MIC）was 152 ± 39.The ratio was 197 ± 44 with high dose therapy.One case of nephrotoxicity was reported due to longer duration of treatment（total 48 d,and 23 d with high dose therapy）.Renal dysfunction was observed in one of the six patients.Three（50%,3/6）patients were clinically and bacteriologically cured after vancomycin treatment.Conclusions When vancomycin is used to treat patients with blood stream infection,the dose should be adjusted according to therapeutic drug monitoring for individualized therapy and the best target therapy concentration.

关 键 词：治疗药物浓度监测 血流感染 万古霉素 最低抑菌浓度 肾毒性 

分 类 号：R96[医药卫生—药理学]