不同剂量万古霉素对MRSA感染患者细菌清除的影响以及血药浓度的相关性分析

Effect of Different Doses of Vancomycin on Clearance of Bacteria in Patients with MRSA Infection and Analysis of Blood Drug Concentration

目的:探究不同剂量万古霉素对耐甲氧西林的金黄色葡萄球菌(MRSA)感染患者细菌清除的影响,并分析感染与血药浓度的关系。方法:收集2017年1月—2018年12月间收治的MRSA感染患者126例临床资料,依据给药剂量分为低剂量组(15 mg·kg^-1·次^-1)40例、中剂量组(17.5 mg·kg^-1·次^-1)42例和高剂量组(20 mg·kg^-1·次^-1)44例;比较3组患者治疗后的临床疗效、血药浓度、细菌清除率、不良反应发生情况,以及治疗前后肾功能的变化情况。结果:高剂量组和中剂量组患者用药后的总有效率分别为97.73%和97.62%显著高于低剂量组的77.50%(P<0.05),细菌清除率分别为97.73%和95.23%显著高于低剂量组的75.00%(P<0.05);3组患者治疗前的血清胱抑素C(CysC)、尿素氮(BUN)、肌酐(SCr)水平值经组间比较其差异均无统计学意义(P>0.05),治疗后高剂量组CysC、BUN、SCr水平值显著高于治疗前(P<0.05),高剂量组显著高于中剂量组和低剂量组(P<0.05);高剂量组治疗后的平均血药浓度显著高于中剂量组和低剂量组,血药谷浓度分布情况显著差于中剂量组和低剂量组(P<0.05);而高剂量组患者的不良反应总发生率(27.27%)显著高于中剂量组(4.76%)和低剂量组(2.50%)(P<0.05)。结论:采用17.5 mg/(kg·次)万古霉素治疗MRSA感染患者的效果较为显著,有效升高了细菌清除率,且血药浓度较低,对患者肾功能影响较小,用药的安全性较高。

Objective:To investigate the effect of different doses of vancomycin on the bacterial clearance rate of patients with methicillin-resistant Staphylococcus aureus(MRSA)infection and to analyze the relationship between blood drug concentration and infected patients.Methods:Clinical data of 126 patients with MRSA infection admitted from January 2017 to December 2018 were collected.Based on the dosing,40 patients in the low-dose group(15 mg·kg^-1·time^-1),42 patients in the medium-dose group(17.5 mg·kg^-1·time^-1),and 44 patients in the high-dose group(20 mg/kg^-1·time^-1)were divided into the low-dose group(15 mg·kg^-1·time^-1),the medium-dose group(17.5 mg·kg-1·time-1)and the high-dose group(20 mg·kg^-1·time^-1).The clinical efficacy,plasma concentration,bacterial clearance rate,adverse reactions,and changes of renal function before and after treatment were compared among the three groups.Results:The total effective rate of high dose group and middle dose group was 97.73%and 97.62%respectively,which was significantly higher than that of low dose group(77.50%)(P<0.05).The bacterial clearance rate of high dose group and middle dose group was 97.73%and 95.23%respectively,which was significantly higher than that of low dose group(75.00%)(P<0.05).There was no significant difference in CysC,BUN and Scr among the three groups before treatment(P>0.05).After treatment,the levels of CysC,BUN and Scr in high dose group were significantly higher than those before treatment,and significantly higher than those in middle dose group and low dose group(P<0.05).After treatment,the average blood concentration of high dose group was significantly higher than that of middle dose group and low dose group,and the distribution of blood drug valley concentration was significantly worse than that of middle dose group and low dose group(P<0.05).The total incidence of adverse reactions in high dose group was27.27%,which was significantly higher than 4.76%and 2.50%in middle dose group and low dose group(P<0.05).Conclusion:The use of vancomycin(17.5 mg·kg^-1·time^-1)in the treatment of MRSA infected patients has the following advantages:a significant effect,effectively increasing the bacterial clearance rate,low blood drug concentration,little impact on the renal function of patients,and high drug safety.