心脏手术中胸骨边缘外用万古霉素膏：肾功能和体型对全身暴露的影响。

IF 3.2 4区医学 Q2 PHARMACOLOGY & PHARMACY

Clinical therapeutics Pub Date : 2025-02-01 DOI:10.1016/j.clinthera.2024.11.024

Meng-Ta Tsai MD, PhD , Yu-Ning Hu MD , Jun-Neng Roan MD, PhD , Chung-Dann Kan MD, PhD , Yi-Chen Wang MD , Chwan-Yau Luo MD, MS , Chen-Hsi Chou PhD

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引用次数: 0

摘要

目的：术中外用万古霉素已广泛应用于多个外科领域，以预防创面感染。然而，关于局部万古霉素全身暴露的研究有限。本研究的目的是调查心脏手术患者胸骨边缘外用万古霉素后的全身暴露。肾功能受损和体型对暴露的影响也进行了检查。方法：对129例成人心脏手术患者胸骨缘外用万古霉素2.5 g。术后第0至7天测量血浆浓度，并使用线性混合效应模型进行分析。结果：60例（46.5%）患者处于慢性肾脏疾病3 - 5期，其中20例患者处于终末期肾脏疾病（ERSD）状态，术前定期进行血液透析。共建立377例血浆万古霉素水平模型。据报道，ESRD患者术后每天万古霉素水平增加7.7%，而非ESRD患者术后每天万古霉素水平下降6.1%。估计肾小球滤过率每增加1 mL/min/1.73 m2，万古霉素浓度下降0.9%。体表面积（BSA）每增加0.1 m2，万古霉素水平降低6.3%。使用10,000个重复的模型模拟报告了万古霉素水平bbb10 mg/L的概率在没有ESRD的患者手术后1周内下降到接近0，即使在肾小球滤过率和BSA估计较低的受试者中也是如此。对于bsa2的ESRD组，万古霉素bbb10 mg/L的可能性高达20% ~ 30%。意义：胸骨边缘外用万古霉素后血浆暴露受肾功能和体型的影响。血浆万古霉素显著水平的低概率支持典型的固定剂量策略。对于接受血液透析的ESRD患者，血浆万古霉素的积累值得警惕。

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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Topical Vancomycin Paste Over the Sternal Edge During Cardiac Surgery: Effects of Renal Function and Body Size on Systemic Exposure

Purpose

Intraoperative topical vancomycin has been widely used in several surgical fields to prevent wound infection. However, there have been limited studies on the systemic exposure of topical vancomycin. The aim of this study was to investigate systemic exposure after topical vancomycin over the sternal edge in cardiac surgical patients. The impact of impaired renal function and body size on the exposure was also examined.

Methods

Topical vancomycin (2.5 g) was applied to the sternal edge in 129 adult cardiac surgical patients. Plasma concentrations were measured on postoperative days 0 through 7 and analyzed using linear mixed-effects models.

Findings

Sixty (46.5%) patients were in chronic kidney disease stages 3 to 5, including 20 patients in end-stage renal disease (ERSD) status with regular hemodialysis preoperatively. A total of 377 plasma vancomycin levels were modeled. It was reported that there was a 7.7% increase in vancomycin level per postoperative day for patients with ESRD in contrast to a decrease of 6.1% each day for patients without ESRD. Every increase of 1 mL/min/1.73 m² in the estimated glomerular filtration rate is associated with a 0.9% decline in vancomycin concentration. Increasing body surface area (BSA) by 0.1 m² reduces the vancomycin level by 6.3%. Model simulations using 10,000 replicates reported that the probability of vancomycin level >10 mg/L declines to near 0 within 1 week after surgery in patients without ESRD, even in subjects with low estimated glomerular filtration rate and BSA. For the ESRD group with a BSA <2 m², the chance of vancomycin >10 mg/L is up to 20% to 30%.

Implications

Plasma exposure after topical vancomycin for the sternal edge is influenced by renal function and body size. The low probability of significant plasma vancomycin levels supports the typical fixed-dose strategy. For patients with ESRD receiving hemodialysis, accumulation of plasma vancomycin is worth cautioning.

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来源期刊

Clinical therapeutics 医学-药学

CiteScore

6.00

自引率

3.10%

发文量

154

审稿时长

9 weeks

期刊介绍： Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.