某院2015年-2020年万古霉素治疗药物监测分析  

Therapeutic Drug Monitoring of Vancomycin in a Hospital from 2015 to 2020

作　　者：符祥俊[1] 肖坚[2] 王和芳[1] 劳行刚[1] 林良沫[1] FU Xiang-jun;XIAO Jian;WANG He-fang;LAO Xing-gang;LIN Liang-mo(Hainan General Hospital(Hainan Affiliated Hospital of Hainan Medical University),Haikou 570311,China;Xiangya Hospital of Central South,Changsha 410001,China)

机构地区：[1]海南省人民医院(海南医学院附属海南医院),海口570311 [2]湖南省中南大学湘雅医院,长沙410001

出　　处：《抗感染药学》2021年第5期737-741,共5页Anti-infection Pharmacy

基　　金：海南省卫生计生行业科研项目(编号:20A200280)。

摘　　要：目的:回顾分析2015年—2020年海南省人民医院(下称"医院")开展万古霉素治疗药物监测的情况和变化趋势,为万古霉素的临床合理使用提供参考。方法:选取2015年1月1日—2020年12月31日医院收治的开展万古霉素治疗药物监测的患者,收集并分析患者的科室分布、血药谷浓度分布情况、急性肾损伤发生情况,以及24 h药时曲线下面积(AUC_(0~24)h)与最低抑菌浓度(MIC)的比值(AUC_(0~24)h/MIC)的分布情况。结果:医院开展万古霉素治疗药物监测的患者和送检科室逐渐增多,万古霉素血药谷浓度的总达标率为39.36%(581/1476),急性肾损伤的发生率为10.65%(59/554)。83例多重耐药革兰阳性菌感染患者开展了AUC_(0~24)h/MIC监测,其总达标率为34.45%;当万古霉素血药谷浓度为15~20 mg/L时,AUC_(0~24)h/MIC达标率为95.00%。结论:医院万古霉素治疗药物监测的开展初步实现规范化和常态化,下一步计划规范MIC的检测,计算出更准确的AUC_(0~24)h/MIC,以指导万古霉素的临床合理使用。Objective:To review and analyze the situation and trend of vancomycin therapeutic drug monitoring in Hainan General Hospital from 2015 to 2020 so as to provide reference for rational clinical use of vancomycin.Methods:Patients,undergoing therapeutic drug monitoring of vancomycin from 2015 to 2020,were selected.The department distribution and vancomycin trough concentration distribution of patients,the incidence of acute kidney injury,and the distribution of AUC_(0~24)h/MIC were collected and analyzed.Results:The number of patients and departments undergoing vancomycin therapeutic drug monitoring increased gradually.The total standard-reaching rate of vancomycin trough concentration was 39.36%(581/1476);the incidence of acute kidney injury was 10.65%(59/554).AUC_(0~24)h/MIC monitoring was carried out in 83 patients infected with drug-resistant gram-positive bacteria,and the total standardreaching rate was 34.45%;The standard-reaching rate of AUC_(0~24)h/MIC was 95.00%when the vancomycin trough concentration was 15~20 mg/L.Conclusion:The therapeutic drug monitoring of vancomycin in the hospital has been initially standardized and normalized.The next step is to standardize the detection of vancomycin’s MIC and calculate the accurate AUC_(0~24)h/MIC so as to guide the rational use of vancomycin in clinic.

关 键 词：万古霉素 治疗药物监测 血药谷浓度 AUC_(0~24)h/MIC 

分 类 号：R969[医药卫生—药理学]