The application of monitoring vancomycin serum trough concentration in ICU patients

GAO Xue-hua; CAO Wen; LI Pei-jie

doi:10.3969/j.issn.1002-1949.2016.06.012

Abstract：Objective To analyze the distribution of serum trough concentration, related factors, clinical efficacy and adverse reactions, by monitoring vancomyc in serum trough concentration in ICU patients. Methods A prospective study was conducted. Data of 106 patients who used vancomycin during December 2012 to May 2015 in medical intensive care unit ( MICU) of the Lanzhou University Second Hospital, were collected and analyzed. According to the endogenous creatinine clearance rate ( CCr) , the patients were divided into two groups:A group ( CCr≥50 mL/min) and B group ( CCr<50 mL/min) . Thirty minutes before the forth dose, recommended by Chinese Expert Consensus for clinical application of vancomycin, blood samples were collected to determine the trough blood concentration by enzyme-multiplied immunoassay technique. The clinical data were collected at the same time. The distribution of vancomyc in serum trough concentration, factors affecting serum trough concentration, efficacy and adverse reactions between two groups were analyzed. Results A total of 106 patients were in accordance with the inclusive criteria, of which 46 patients in group A and 60 patients in group B. In group A, 63. 0% of them reached the targeting serum trough concentration (10~20 mg/L), 26. 1% of them <10 mg/L and 10. 9% of them >20 mg/L. In group B, 55. 0% of them reached the target concentration(10~20 mg/L), 18. 3% of them <10 mg/L and 26. 7% of them >20 mg/L. Between group A and group B, the distribution of vancomycin serum trough concentration was significantly different(P<0. 05). Age(OR=0. 962, 95%CI 0. 917 ~1. 016,P=0. 025), weight(OR=1. 008, 95%CI 0. 934~1. 071, P=0. 033), serum albumin level(OR=1. 102, 95%CI 1. 024~1. 203, P=0. 028), endogenous creatinine clearance rate(OR=1. 006, 95%CI 0. 992~1. 013, P=0. 000) and vancomycin doses(OR=0. 715, 95%CI 0. 238 ~1. 260, P=0. 008) were found to be correlated to serum trough concentration by multiple linear regression analysis. After adjustment of vancomycin dosages according to serum trough concentration, there were no significant differences in times took to reach target trough concentration, efficacy and adverse reactions(P >0. 05). Conclusion Though achieving the recommended doses by Chinese Expert Consensus in 2011, vancomycin serum trough concentration of some patients cannot reach target concentration (10~20 mg/L). Age, weight, serum albumin level, endogenous creatinine clearance rate and vancomycin doses show relatively significant influences to serum trough concentration. After individualized dosing, patients with different renal function can still achieve the same efficacy and avoid aggravating adverse reactions.