血流感染患者万古霉素血药谷浓度变化情况及其相关因素研究

Study on the Change of Vancomycin Blood Trough Concentration and Its Related Factors in Patients with Bloodstream Infection

目的:分析血流感染患者万古霉素血药谷浓度变化情况,并分析诱发其血药谷浓度变化的相关因素,以期为血流感染患者提供更加合理的个体化用药方案。方法:回顾性分析2021年1月—2022年8月期间我院收治的118例耐甲氧西林金黄色葡萄球菌所致的血流感染患者的病历资料,所有患者均给予万古霉素治疗,于第5次给药前30min测定万古霉素稳态谷浓度,收集所有患者的临床资料,并分析血流感染患者万古霉素血药谷浓度变化情况及其相关因素。结果:118例血流感染患者在万古霉素使用期间共监测247次,平均血药谷浓度为(17.53±4.71)mg/L,其中万古霉素血药谷浓度在<10mg/L的患者共20例,占16.95%,10~20mg/L的患者共79例,占66.95%,>20mg/L的患者共19例,占16.10%;不同万古霉素血药谷浓度达标情况的血流感染患者的年龄、急性肾损伤、低蛋白血症、急性C反应蛋白(CRP)水平比较,差异有统计学意义(P<0.05);经有序Logistic回归分析显示,急性肾损伤、低蛋白血症、CRP是血流感染患者万古霉素血药谷浓度不达标的危险因素(P<0.05)。结论:血流感染患者万古霉素血药谷浓度不达标率较高,其中急性肾损伤、低蛋白血症、CRP是影响血流感染患者万古霉素血药谷浓度达标率的相关因素。

Objective:To analyze the change of vancomycin blood trough concentration in patients with blood flow infection,and analyze the related factors that induce the change of vancomycin blood trough concentration,so as to provide more reasonable individualized drug regimen for patients with blood flow infection.Methods:The medical records of 118 patients with blood flow infection caused by MRSA admitted to our hospital from January 2021 to August 2022 were analyzed retrospectively.All patients were treated with vancomycin.The steady-state valley concentration of vancomycin was measured 30 minutes before the fifth administration.The clinical data of all patients were collected,and the changes of the blood valley concentration of vancomycin in patients with blood flow infection and its related factors were analyzed.Results:118 patients with blood flow infection were monitored 247 times during the use of vancomycin,and the average blood trough concentration was(17.53±4.71)mg/L.Among them,20 patients(16.95%)had vancomycin blood trough concentration<10mg/L,79 patients(66.95%)had vancomycin blood trough concentration 10~20mg/L,and 19 patients(16.10%)had vancomycin blood trough concentration>20mg/L.The age,acute renal injury,hypoproteinemia,and acute C-reactive protein(CRP)levels of blood flow infection patients with different levels of vancomycin blood trough concentration were statistically significant(P<0.05).By ordered Logistic regression analysis,the results showed that acute renal injury,hypoproteinemia and CRP were the risk factors for vancomycin to fail to reach the blood grain level in patients with blood flow infection(P<0.05).Conclusion:The failure rate of vancomycin in patients with blood flow infection is relatively high,among which acute renal injury,hypoproteinemia and CRP are related factors affecting the failure rate of vancomycin in patients with blood flow infection.