반코마이신 치료 약물 모니터링에서 간헐적 투여와 지속적 투여에 따른 효과 및 안전성 비교
Comparison of Efficacy and Safety Depending on Intermittent and Continuous Infusion in Vancomycin TDM
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Background : Continuous infusion (CI) of vancomycin achieves faster target trough concentrations and re duces the risk of nephrotoxicity compared to intermittent infusion (II). However, data comparing their efficacy and safety are limited. This study evaluates the efficacy and safety of CI versus II in patients with MRSA infec tions. Methods : A single center study included patients with MRSA between June 2022 and January 2024. Patients received vancomycin via intermittent infusion (II) or continuous infusion (CI) for at least three days, with thera peutic drug monitoring (TDM) data collected. The primary outcomes were microbiological eradication at days 7 and 14, time to reach target vancomycin levels, and resolution of fever. Secondary outcomes included changes in white blood cell (WBC) count and C-reactive protein (CRP) levels. Safety was assessed by the incidence of acute kidney injury (AKI). Results : A total of 68 patients were included, with 45 in the II group and 23 in the CI group. Microbiological eradication rates at day 7 were not significantly different between the groups (64% vs. 56%, P=0.31). Howev er, by day 14, a statistically significant difference was observed, with eradication rates of 86% for the CI group compared to 64% for the II group (P < 0.01). No significant differences were noted in WBC or CRP reductions. Fever resolution within 5 days was higher in the II group (P=0.01). The time to achieve the target vancomycin trough concentration was significantly shorter in the CI group compared to the II group (5.45±3.44 days vs. 7.76±4.05 days, P=0.04). Acute kidney injury (AKI) occurred in 15% of patients in the CI group and 16% in the II group, with no statistically significant differ ence (P > 0.99). Conclusion : CI was associated with higher microbiological eradication by day 14 and a faster attainment of target vancomycin levels, with no significant difference in AKI incidence between the groups. Further research is needed to account for infection severity and variability in infection sites.
Abstract
Background : Continuous infusion (CI) of vancomycin achieves faster target trough concentrations and re duces the risk of nephrotoxicity compared to intermittent infusion (II). However, data comparing their efficacy and safety are limited. This study evaluates the efficacy and safety of CI versus II in patients with MRSA infec tions. Methods : A single center study included patients with MRSA between June 2022 and January 2024. Patients received vancomycin via intermittent infusion (II) or continuous infusion (CI) for at least three days, with thera peutic drug monitoring (TDM) data collected. The primary outcomes were microbiological eradication at days 7 and 14, time to reach target vancomycin levels, and resolution of fever. Secondary outcomes included changes in white blood cell (WBC) count and C-reactive protein (CRP) levels. Safety was assessed by the incidence of acute kidney injury (AKI). Results : A total of 68 patients were included, with 45 in the II group and 23 in the CI group. Microbiological eradication rates at day 7 were not significantly different between the groups (64% vs. 56%, P=0.31). Howev er, by day 14, a statistically significant difference was observed, with eradication rates of 86% for the CI group compared to 64% for the II group (P < 0.01). No significant differences were noted in WBC or CRP reductions. Fever resolution within 5 days was higher in the II group (P=0.01). The time to achieve the target vancomycin trough concentration was significantly shorter in the CI group compared to the II group (5.45±3.44 days vs. 7.76±4.05 days, P=0.04). Acute kidney injury (AKI) occurred in 15% of patients in the CI group and 16% in the II group, with no statistically significant differ ence (P > 0.99). Conclusion : CI was associated with higher microbiological eradication by day 14 and a faster attainment of target vancomycin levels, with no significant difference in AKI incidence between the groups. Further research is needed to account for infection severity and variability in infection sites.