摘要
目的探讨血药浓度监测在万古霉素治疗耐甲氧西林金黄色葡萄球菌(MRSA)颅内感染中的价值。方法回顾性分析2017年5月至2019年10月收治的75例MRSA颅内感染的临床资料。根据血药浓度分为低浓度组(30例,谷浓度10~14 mg/L)和高浓度组(45例,谷浓度15~20 mg/L)。结果高浓度组有效率(82.22%,37/45)明显高于低浓度组(60.00%,18/30;P<0.05)。低浓度组发生不良反应28例,肝功能异常1例,皮疹1例;高浓度组发生不良反应39例、肝功能异常2例、皮疹3例、中性粒细胞减少1例;调整给药方案后,均恢复正常。两组不良反应发生率无统计学差异(P>0.05)。两组均未出现耳毒性、肾毒性不良反应。多因素logistic回归分析显示,万古霉素谷浓度<15 mg/L、肾小球滤过率<60 ml/min、血肌酐≥133μmol/L、用药时间≥2周是万古霉素治疗无效的独立危险因素(P<0.05)。ROC曲线分析显示,万古霉素谷浓度预测疗效的曲线下面积为0.778(95%置信区间0.648~0.905)。万古霉素谷浓度≥15.91 mg/L预测治疗有效的敏感性为0.673,特异性为0.802。结论万古霉素治疗MRSA颅内感染,谷浓度在15~20 mg/L的临床疗效更好,同时需关注治疗时间、血肌酐和肾小球滤过率等指标。
Objective To explore the value of blood drug concentration monitoring in the vancomycin treatment for the patients with intracranial infection caused by methicillin-resistant staphylococcus aureus(MRSA).Methods The clinical data of 75 patients with intracranial infection caused MRSA who were admitted to our hospital from May 2017 to October 2019 were analyzed retrospectively.The blood drug concentration monitoring was performed on all the patients.Results The trough concentration of vancomycin ranged from 10 mg/L to 14 mg/L in 30 patients(low concentration group)and from 15 mg/L to 20 mg/L in 45 patients(high concentration group).The clinical effective rate of high concentration group(82.22%,37/45)was significantly higher than that(60.00%,18/30)of low high concentration group(P<0.05).There were no signifcant differences in the rates of adverse reactions,abnormal liver function,skin rash,and neutropenia between the two groups(P>0.05).No nephrotoxicity or ototoxicity occurred in the two groups.Multivariate logistic regression analysis showed that vancomycin trough concentration<15 mg/L,glomerular filtration rate<60 ml/min,serum creatinine≥133μmol/L,and medication time≥2 weeks were independent risk factors for the ineffectiveness of vancomycin treatment(P<0.05).ROC curve analysis showed that the area under curve for predicting the efficacy of vancomycin trough concentration was 0.778(95%confidence interval 0.648~0.905).The sensitivity and specificity of trough concentration of vancomycin≥15.91 mg/L to predict therapeutic effectiveness were 0.673 and 0.802,respectively.Conclusions When the vancomycin is used to treat MRSA intracranial infections,the clinical effect is better as the trough concentration is in the range of 15~20 mg/L.At the same time,attention should be paid to the indicators such as treatment time,serum creatinine and glomerular filtration rate.
作者
李庆岗
程岗
张剑宁
LI Qing-gang;Cheng Gang;ZHANG Jian-ning(Department of Neurosurgery,The First Medical Center of PLA General Hospital,Beijing 100048,China)
出处
《中国临床神经外科杂志》
2021年第4期243-245,249,共4页
Chinese Journal of Clinical Neurosurgery
基金
军队后勤科研计划课题(AHJ14J001)。
