Clinical Efficacy and Safety of Vancomycin Based on Unbound Vancomycin Concentration Monitoring.

IF 2.8 4区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Therapeutic Drug Monitoring Pub Date : 2024-12-10 DOI:10.1097/FTD.0000000000001292

Fefei Ren, Shan Li, Yixin Liu, Xiangchen Li, Xikun Wu, Zhiqing Zhang

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引用次数: 0

Abstract

Objective: To monitor total trough concentration (Cmin_total) and unbound trough concentration (Cmin_free) of vancomycin in clinical samples and analyze the factors influencing them, and to assess their correlation with clinical efficacy and acute kidney injury (AKI).

Methods: Plasma samples were processed by protein precipitation, followed by hollow-fiber centrifugal ultrafiltration to separate unbound vancomycin from plasma. Thereafter, Cmin_total and Cmin_free were determined using high-performance liquid chromatography. Clinical data of patients were collected. Factors affecting vancomycin Cmin_total, Cmin_free, and their correlation with clinical efficacy and nephrotoxicity were investigated.

Results: A total of 146 samples from 105 included patients were collected. Cmin_total and Cmin_free of vancomycin ranged from 0.62 to 56.08 mcg·mL-1 and 0.61-38.51 mcg·mL-1, respectively. Cmin_total and Cmin_free were correlated (r = 0.8899), influenced by basal creatinine and cystatin C. Higher level of Cmin_free (˃8.6 mcg·mL-1) and nephrotoxic drugs concomitant were risk factors of vancomycin-associated AKI (P < 0.05); Cmin_total and Cmin_free thresholds of vancomycin-associated AKI were 15.35 and 6.83 mcg·mL-1, respectively.

Conclusions: vancomycin Cmin_total and Cmin_free, higher Cmin_total and Cmin_free were correlated and higher concentrations of both may increase the risk of AKI.

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基于非结合万古霉素浓度监测的万古霉素临床疗效及安全性。

目的：监测万古霉素临床样品的总谷浓度（Cmin_total）和游离谷浓度（Cmin_free），分析其影响因素，并评价其与临床疗效和急性肾损伤（AKI）的相关性。方法：血浆样品经蛋白沉淀处理后，采用中空纤维离心超滤分离血浆中未结合的万古霉素。然后用高效液相色谱法测定Cmin_total和Cmin_free。收集患者的临床资料。探讨万古霉素Cmin_total、Cmin_free的影响因素及其与临床疗效和肾毒性的相关性。结果：共收集105例患者标本146份。万古霉素的Cmin_total和Cmin_free分别为0.62 ~ 56.08 mcg·mL-1和0.61 ~ 38.51 mcg·mL-1。Cmin_total和Cmin_free呈相关性（r = 0.8899），受基础肌酐和胱抑素c的影响。Cmin_free水平升高（8.6 mcg·mL-1）和肾毒性药物的伴随是万古霉素相关性AKI的危险因素（P < 0.05）；万古霉素相关AKI的Cmin_total和Cmin_free阈值分别为15.35和6.83 mcg·mL-1。结论：万古霉素Cmin_total和Cmin_free与较高的Cmin_total和Cmin_free存在相关性，两者浓度较高均可增加AKI的发生风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Drug Monitoring 医学-毒理学

CiteScore

5.00

自引率

8.00%

发文量

213

审稿时长

4-8 weeks

期刊介绍： Therapeutic Drug Monitoring is a peer-reviewed, multidisciplinary journal directed to an audience of pharmacologists, clinical chemists, laboratorians, pharmacists, drug researchers and toxicologists. It fosters the exchange of knowledge among the various disciplines–clinical pharmacology, pathology, toxicology, analytical chemistry–that share a common interest in Therapeutic Drug Monitoring. The journal presents studies detailing the various factors that affect the rate and extent drugs are absorbed, metabolized, and excreted. Regular features include review articles on specific classes of drugs, original articles, case reports, technical notes, and continuing education articles.