肾功能亢进对耐甲氧西林金黄色葡萄球菌感染患儿万古霉素血药浓度及治疗效果的影响分析

Effect of augmented renal clearance on plasma concentration of vancomycin and treatment outcome in children with methicillin-resistant Staphylococcus aureus infection

目的研究肾功能亢进(ARC)对万古霉素治疗儿童耐甲氧西林金黄色葡萄球菌(MRSA)感染时的血药浓度、细菌学疗效及临床疗效的影响。方法回顾性研究2013年1月至2017年7月期间因明确MRSA感染使用万古霉素,并进行血药浓度监测的60例危重患儿的病例资料,根据肾小球滤过率(eGFR)分为ARC组(n=19)和肾功能正常组(n=41),对两组患儿在万古霉素使用、血药浓度及治疗效果等方面进行统计学比较分析。结果 ARC组的年龄主要分布在1~12岁,其体重和体表面积明显大于肾功能正常组(P < 0.05)。ARC组初始万古霉素血药谷浓度明显低于肾功能正常组,且ARC组达有效血药谷浓度(10~20 mg/L)比例低于肾功能正常组(P < 0.05)。两组在细菌学疗效评价和临床疗效评价方面比较差异均无统计学意义(P > 0.05),但ARC组的儿童重症监护室(PICU)住院时间及总住院时间明显长于肾功能正常组(P < 0.05)。结论 ARC明显降低MRSA感染患儿的万古霉素血药谷浓度,延长PICU住院时间及总住院时间。临床上应注意对ARC患儿施行个体化给药治疗。

Objective To investigate the effect of augmented renal clearance(ARC) on plasma concentration of vancomycin, bacteriological outcome, and clinical outcome in children with methicillin-resistant Staphylococcus aureus(MRSA) infection treated by vancomycin. Methods A retrospective analysis was performed for the clinical data of 60 critically ill children who were treated with vancomycin due to MRSA infection from January 2013 to July 2017 and underwent plasma concentration monitoring. According to estimated glomerular filtration rate, these children were divided into an ARC group with 19 children and a normal renal function group with 41 children. The two groups were compared in terms of the use of vancomycin, plasma concentration of vancomycin, and treatment outcome. Results The children in the ARC group had an age of 1-12 years, and the ARC group had significantly higher body weight and body surface area than the normal renal function group(P<0.05). Compared with the normal renal function group, the ARC group had a significantly lower initial trough concentration of vancomycin and a significantly lower proportion of children who achieved the effective trough concentration of vancomycin(10-20 mg/L)(P<0.05). There were no significant differences in bacteriological outcome and clinical outcome between the two groups(P>0.05), but the ARC group had significantly longer length of stay in the pediatric intensive care unit(PICU) and length of hospital stay than the normal renal function group(P<0.05). Conclusions ARC can significantly reduce the trough concentration of vancomycin and prolong the length of PICU stay and the length of hospital stay in children with MRSA infection. Idividualized medication should be administered to children with ARC.