Phân tích tình hình sử dụng và giám sát nồng độ vancomycin trong máu trên bệnh nhân người lớn tại Bệnh viện Đa khoa quốc tế Hải Phòng

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Tác giả: Hoàng Anh Nguyễn, Thanh Hồi Nguyễn, Thị Thu Phương Nguyễn, Vân Anh Trần, Đình Hòa Vũ

Ngôn ngữ: vie

Ký hiệu phân loại: 543.4 Electrochemical analysis

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2022

Mô tả vật lý: 270-274

Bộ sưu tập: Metadata

ID: 498767

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Nghiên cứu hồi cứu trên bệnh án của 142 bệnh nhân có sử dụng theo dõi nồng độ thuốc trong máu (TDM, therapeutic drug monitoring) của vancomycin nhằm mục đích khảo sát các đặc điểm chính của bệnh nhân, đặc điểm vi sinh và đặc điểm TDM vancomycin tại Bệnh viện Đa khoa Quốc tế Hải Phòng. Bệnh nhân có trung vị tuổi là 51 tuổi với chức năng thận nền khác biệt đáng kể, được phản ánh qua giá trị thanh thải creatinin, với trung vị là 83,8 mL/phút. Trong số các căn nguyên vi sinh được phân lập, MRSA chiếm đa số với tỷ lệ 77,2%. Liều nạp được sử dụng ở 40,2% bệnh nhân được chỉ định truyền ngắt quãng (trung vị 28,9 mg/kg) và 80% bệnh nhân được chỉ định truyền liên tục (trung vị 27,3 mg/kg). Với đối tượng được truyền ngắt quãng, tổng liều duy trì vancomycin thường dùng là 2g/24h hoặc chế độ liều cao (3g/24 giờ). Kết quả TDM nồng độ đáy vancomycin biến thiên rõ rệt giữa các bệnh nhân. Phần trăm tích lũy đạt nồng độ đáy mục tiêu ở lần TDM thứ hai có cải thiện so với lần đầu (49,6% so với 40,9% đối với truyền ngắt quãng và 53,3% so với 40% đối với truyền liên tục). Kết quả nghiên cứu nhấn mạnh tầm quan trọng của TDM vancomycin nhằm cá thể hóa điều trị để tối ưu hiệu quả và hạn chế độc tính của thuốc.This study aimed to describe the use of vancomycin on adult patients and the routine therapeutic drug monitoring (TDM) activity in Haiphong International Hospital according to the institutional approved guideline. Information of vancomycin use and TDM of 142 admitted patients from 2019 to 2020 were retrospectively reviewed. The patients median age was 51 years [IQR: 34 - 67]. Renal function fluctuated substantially with median Clcr was 83.8 mL/min [IQR: 62.8-110.8]. The most common isolated pathogen was MRSA (n = 88
77.2%). Loading dose was observed in 40.2% of patients receiving intermittent infusions with a median of 28.8 mg/kg and in 80% of patients receiving continuous infusions with a median of 27.3 mg/kg. Among patients receiving intermittent infusions, a total maintenance dose at 2g or 3g over 24h was used on patients with different renal function. The vancomycin trough concentrations showed a high inter-individual variation. Dose adjustment increased vancomycin levels but not significantly from 10.9 mg/L to 14.1 mg/L, p = 0.554 with intermittent infusion and from 21.7 mg/L to 23.9 mg/L, p=0.312 with continuous infusion. The target concentration attainment was improved after 1st and 2nd dose adjustment from 40.9% to 49.6% in intermittent infusion and from 40.0 % to 53.3% in continuous infusion. These findings emphasize the necessity of TDM vancomycin in individualizing the vancomycin use to maximize the efficacy while avoiding the toxicity.

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