Differences in Vancomycin Clearance between Trauma and Medical Intensive Care Unit Patients
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: To identify the differences in the vancomycin pharmacokinetics between multiple trauma patients and medically ill patients in the intensive care unit (ICU) stratified by the use of continuous renal replacement therapy (CRRT), and the factors affecting vancomycin clearance (CLvan). Materials and Methods: All the included patients received at least three consecutive doses of vancomycin, then, therapeutic drug monitoring was conducted. Patients' serum vancomycin trough levels and other clinical variables were identified retrospectively. The vancomycin pharmacokinetics and associated factors were compared and analyzed between trauma ICU (TICU) and medical ICU (MICU) patients. Results: In the non-dialyzed group, the CLvan was higher among the TICU patients than the MICU patients. However, in the continuous renal replacement therapy group, there was no significant difference in the CLvan between the multiple trauma and medically ill patients. The only factor associated with CLvan in the non-dialyzed group was creatinine clearance; none of the factors was associated with CLvan in the CRRT group. Conclusion: In the case of non-dialyzed patients in the TICU, vancomycin dosages must be adjusted, depending on the patient's actual body weight changes. In the case of patients undergoing CRRT in both ICUs, vancomycin can be infused with fixed doses regardless of the patients' characteristics.
Abstract
Background: To identify the differences in the vancomycin pharmacokinetics between multiple trauma patients and medically ill patients in the intensive care unit (ICU) stratified by the use of continuous renal replacement therapy (CRRT), and the factors affecting vancomycin clearance (CLvan). Materials and Methods: All the included patients received at least three consecutive doses of vancomycin, then, therapeutic drug monitoring was conducted. Patients' serum vancomycin trough levels and other clinical variables were identified retrospectively. The vancomycin pharmacokinetics and associated factors were compared and analyzed between trauma ICU (TICU) and medical ICU (MICU) patients. Results: In the non-dialyzed group, the CLvan was higher among the TICU patients than the MICU patients. However, in the continuous renal replacement therapy group, there was no significant difference in the CLvan between the multiple trauma and medically ill patients. The only factor associated with CLvan in the non-dialyzed group was creatinine clearance; none of the factors was associated with CLvan in the CRRT group. Conclusion: In the case of non-dialyzed patients in the TICU, vancomycin dosages must be adjusted, depending on the patient's actual body weight changes. In the case of patients undergoing CRRT in both ICUs, vancomycin can be infused with fixed doses regardless of the patients' characteristics.
참고문헌 (23)
- Kohl BA, "The inflammatory response to surgery and trauma", Curr Opin Crit Care, 12, pp.325~332 (2006)
- Sedlář M, "Early and subacute inflammatory response and long-term survival after hip trauma and surgery", Arch Gerontol Geriatr, 60, pp.431~436 (2015)
- Bunnell KL, "Methicillin-resistant Staphylococcus aureus pneumonia in critically ill trauma and burn patients: a retrospective cohort study", Surg Infect (Larchmt), 18, pp.196~201 (2017)
- Rybak MJ, "Vancomycin therapeutic guidelines : a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists", Clin Infect Dis, 49, pp.325~327 (2009)
- McKenzie C, "Antibiotic dosing in critical illness", J Antimicrob Chemother, 66(Suppl 2), pp.ii25~ii31 (2011)
- Rybak MJ., "The pharmacokinetic and pharmacodynamic properties of vancomycin", Clin Infect Dis, 42(Suppl 1), pp.S35~S39 (2006)
- Rybak M, "Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists", Am J Health Syst Pharm, 66, pp.82~98 (2009)
- Scaglione F, "Pharmacokinetics", pharmacodynamics of antibacterials in the intensive care unit : setting appropriate dosing regimens, 2008, pp.32, 294~301
- Pea F, "High vancomycin dosage regimens required by intensive care unit patients cotreated with drugs to improve haemodynamics following cardiac surgical procedures", J Antimicrob Chemother, 45, pp.329~335 (2000)
- Cockcroft DW, "Prediction of creatinine clearance from serum creatinine", Nephron, 16, pp.31~41 (1976)
- Mahmoud SH, "Augmented renal clearance in critical illness: an important consideration in drug dosing", Pharmaceutics, 9, pp.pii:E36~ (2017)
- RENAL Replacement Therapy Study Investigators, "Intensity of continuous renal-replacement therapy in critically ill patients", N Engl J Med, 361, pp.1627~1638 (2009)
- Baker SP, "The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care", J Trauma, 14, pp.187~196 (1974)
- Metnitz PG, "SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description", Intensive Care Med, 31, pp.1336~1344 (2005)
- Ghosh SK, "Basics of Bayesian methods", Methods Mol Biol, 620, pp.155~178 (2010)
- Udy AA, "Augmented renal clearance : implications for antibacterial dosing in the critically ill", Clin Pharmacokinet, 49, pp.1~16 (2010)
- Lin Wu FL, "A larger dose of vancomycin is required in adult neurosurgical intensive care unit patients due to augmented clearance", Ther Drug Monit, 37, pp.609~618 (2015)
- Medellín-Garibay SE, "Pharmacokinetics of vancomycin and dosing recommendations for trauma patients", J Antimicrob Chemother, 71, pp.471~479 (2016)
- Minville V, "Increased creatinine clearance in polytrauma patients with normal serum creatinine : a retrospective observational study", Crit Care, 15, pp.R49~ (2011)
- Campassi ML, "Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment", Rev Bras Ter Intensiva, 26, pp.13~20 (2014)
- De Waele JJ, "Epidemiology of augmented renal clearance in mixed ICU patients", Minerva Anestesiol, 81, pp.1079~1085 (2015)
- Choi G, "Principles of antibacterial dosing in continuous renal replacement therapy", Crit Care Med, 37, pp.2268~2282 (2009)
- DelDot ME, "Vancomycin pharmacokinetics in critically ill patients receiving continuous venovenous haemodiafiltration", Br J Clin Pharmacol, 58, pp.259~268 (2004)