노인에서 혈청 Cystatin C 농도를 이용한 반코마이신 투여용량 평가
Evaluation of the Effect of Initial dose of Vancomycin using Serum Cystatin C as a Marker in Elderly Patients
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Background:It has been suggested that the glomerular filtration rate can be predicted on the basis of serum cystatin C concentration. The aim of this study was to investigate the clinical utility of serum cystatin C as a marker of renal function and to evaluate the effect of an initial dose of vancomycin using serum cystatin C concentration in elderly patients. Materials and Methods:Data was collected from July 2006 to September 2008. The subjects were elderly patients (≥60-years-of-age; n=number of patients) who had been treated with vancomycin. Serum concentrations of parameters including vancomycin, creatinine, and cystatin C were measured. Correlations between measured vancomycin concentrations and predicted vancomycin concentrations based on serum cystatin C or serum creatinine were compared, and the initial dose setting of vancomycin on the basis of serum cystatin C concentration was evaluated. Results:Serum cystatin C was a good marker of renal function in comparison with serum creatinine for various doses of vancomycin in the elderly subject. In subpopulation (n=88) with normal serum cystatin C level (≤1.2 mg/L) who were treated with routine adult vancomycin dose (1g q 12 hours), vancomycin concentration was within the therapeutic range (5-15 mg/L) in 68 patients (77.3%), and was <20 mg/L in 77 of the 88 patients (88.5 %). Conclusions:Predictive prowess of serum vancomycin concentrations on the basis of the serum cystatin C concentration could be better than that based on the serum creatinine concentration in elderly patients.
Abstract
Background:It has been suggested that the glomerular filtration rate can be predicted on the basis of serum cystatin C concentration. The aim of this study was to investigate the clinical utility of serum cystatin C as a marker of renal function and to evaluate the effect of an initial dose of vancomycin using serum cystatin C concentration in elderly patients. Materials and Methods:Data was collected from July 2006 to September 2008. The subjects were elderly patients (≥60-years-of-age; n=number of patients) who had been treated with vancomycin. Serum concentrations of parameters including vancomycin, creatinine, and cystatin C were measured. Correlations between measured vancomycin concentrations and predicted vancomycin concentrations based on serum cystatin C or serum creatinine were compared, and the initial dose setting of vancomycin on the basis of serum cystatin C concentration was evaluated. Results:Serum cystatin C was a good marker of renal function in comparison with serum creatinine for various doses of vancomycin in the elderly subject. In subpopulation (n=88) with normal serum cystatin C level (≤1.2 mg/L) who were treated with routine adult vancomycin dose (1g q 12 hours), vancomycin concentration was within the therapeutic range (5-15 mg/L) in 68 patients (77.3%), and was <20 mg/L in 77 of the 88 patients (88.5 %). Conclusions:Predictive prowess of serum vancomycin concentrations on the basis of the serum cystatin C concentration could be better than that based on the serum creatinine concentration in elderly patients.
참고문헌 (20)
- Cockcroft DW, "Prediction of creatinine clearance from serum creatinine", Nephron, 16, pp.31~41 (1976)
- Branten AJ, "Serum creatinine is a poor marker of GFR in nephrotic syndrome", Nephrol Dial Transplant, 20, pp.707~711 (2005)
- Verhave JC, "Estimation of renal function in subjects with normal serum creatinine levels: influence of age and body mass index", Am J Kidney Dis, 46, pp.233~241 (2005)
- Rybak MJ, "Chandrasekar PH. Nephrotoxicity of vancomycin, alone and with an aminoglycoside", J Antimicrob Chemother, 25, pp.679~687 (1990)
- Rybak MJ, "Albrecht LM, Boike SC, Chandrasekar PH. Nephrotoxicity of vancomycin, alone and with an aminoglycoside", J Antimicrob Chemother, 25, pp.679~687 (1990)
- Filler G, "Cystatin C as a marker of GFR--history, indications, and future research", Clin Biochem, 38, pp.1~8 (2005)
- Okamoto G, "Serum cystatin C as a better marker of vancomycin clearance than serum creatinine in elderly patients", Clin Biochem, 40, pp.485~490 (2007)
- Christensson A, "Serum cystatin C is a more sensitive and more accurate marker of glomerular filtration rate than enzymatic measurements of creatinine in renal transplantation", Nephron Physiol, 94, pp.19~27 (2003)
- Pge U, "Calculation of glomerular filtration rate based on cystatin C in cirrhotic patients", Nephrol Dial Transplant, 21, pp.660~664 (2006)
- Elliott TS, "Working Party of the British Society for Antimicrobial Chemotherapy", J Antimicrob Chemother, 54, pp.971~981 (2004)
- American Thoracic Society; Infectious Diseases Society of America, "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia", Am J Respir Crit Care Med, 171, pp.388~416 (2005)
- Tunkel AR, "Practice guidelines for the management of bacterial meningitis", Clin Infect Dis, 39, pp.1267~1284 (2004)
- Wysocki M, "Continuous versus intermittent infusion of vancomycin in severe Staphylococcal infections: prospective multicenter randomized study", Antimicrob Agents Chemother, 45, pp.2460~2467 (2001)
- Tanaka A, "Estimation of the initial dose setting of vancomycin therapy with use of cystatin C as a new marker of renal function", Ther Drug Monit, 29, pp.261~264 (2007)
- Hermida J, "Serum cystatin C for the prediction of glomerular filtration rate with regard to the dose adjustment of amikacin, gentamicin, tobramycin, and vancomycin", Ther Drug Monit, 28, pp.326~331 (2006)
- Coll E, "cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment", Am J Kidney Dis, 36, pp.29~34 (2000)
- 최낙원, "신장이식 환자에서 혈청 cystatin C치와 사구체여과율의연관성", 대한내과학회지, 70(6), pp.672~680 (2006), 대한내과학회
- 한금현, "사구체 여과율의 지표로서 혈청 크레아티닌과 비교한 혈청 Cystatin C 농도", Kidney Research and Clinical Practice, 25(5), pp.737~744 (2006), 대한신장학회
- Kollef MH, "Limitations of vancomycin in the management of resistant Staphylococcal infections", Clin Infect Dis 45 Suppl, 3, pp.S191~195 (2007)
- Trotman RL, "Antibiotic dosing in critically ill adult patients receiving continuous renal replacement therapy", Clin Infect Dis, 41, pp.1159~1166 (2005)