万古霉素血清谷浓度监测对革兰阳性(G^+)球菌血流感染患者个体化用药方案的影响

Effect of Vancomycin Serum Trough Concentration Monitoring on Individualized Drug Regimen in Patients with Gram-positive(G^+) Cocci Infection

目的研究万古霉素血清谷浓度监测对革兰阳性(G+)球菌血流感染患者个体化用药方案的影响。方法选取该院2014年1月—2018年7月收治的G+球菌血流感染患者22例作为研究对象,均应用万古霉素治疗,并测定万古霉素血清谷浓度,分析临床疗效及肾毒性发生情况。结果经细菌培养可知,22例G+球菌血流感染患者中,屎肠球菌感染12例,占54.55%(12/22),耐甲氧西林金黄色葡萄球菌感染10例,占45.45%(10/22)。治疗后临床治愈率为31.82%(7/22),临床无效率为68.18%(15/22)。22例患者共监测万古霉素血清谷浓度33例次,其中达到靶浓度10~15μg/mL为12例次,占36.36%(12/33),两者万古霉素血清谷浓度分布情况相比,差异无统计学意义(P>0.05);临床治愈者万古霉素血清谷浓度与临床无效者比较,差异无统计学意义(t=0.607);临床治愈者肾毒性发生率0.00%(0/7)较临床无效者26.67%(4/15)低,但差异无统计学意义(P>0.05)。结论G+球菌血流感染患者采取万古霉素血清谷浓度监测可为个体化用药方案提供信息支持,达到改善临床效果,降低肾毒性的目的。

Objective To study the effect of vancomycin serum trough concentration monitoring on individualized drug regimen in patients with Gram-positive (G+) cocci infection.Methods 22 patients with G+ cocci infection were enrolled in our hospital from January 2014 to July 2018.All patients were treated with vancomycin.The serum concentration of vancomycin was measured to analyze the clinical efficacy and nephrotoxicity occurrance.Results According to bacterial culture,among the 22 patients with G+ cocci infection,12 cases of enterococcus faecium infection accounted for 54.55%(12/22),and 10 cases of methicillin-resistant staphylococcus aureus infection,accounting for 45.45%(10/22).The clinical cure rate after treatment was 31.82%(7/22),and the clinical invalid rate was 68.18%(15/22).A total of 33 cases of vancomycin serum trough concentration were monitored in 22 patients,of which 12 cases reached a target concentration of 10-15 μg/mL,accounting for 36.36%(12/33),and the distribution of vancomycin serum trough concentrations There was no statistically significant difference in the ratio (P>0.05).The serum concentration of vancomycin in clinically cured patients was not statistically significant (t=0.607).The incidence of nephrotoxicity in clinically cured patients was 0.00%(0/7) was lower than clinically ineffective patients 26.67%(4/15),but the difference was not statistically significant (P>0.05).Conclusion The monitoring of vancomycin serum trough concentration in patients with G+ cocci blood flow infection can provide information support for individualized drug use,and achieve the purpose of improving clinical effect and reducing nephrotoxicity.