BACKGROUND:The present study aims to investigate whether mannitol facilitates central nervous system(CNS) entry of vancomycin and alleviates methicillin-resistant Staphylococcus aureus(MRSA)intracranial infection.METH...BACKGROUND:The present study aims to investigate whether mannitol facilitates central nervous system(CNS) entry of vancomycin and alleviates methicillin-resistant Staphylococcus aureus(MRSA)intracranial infection.METHODS:Blood-brain barrier(BBB) permeability was assessed by measuring the concentration of sodium fl uorescein(NaF) in the brain tissues of rats and fl uorescein isothiocyanate-dextran(FITC-dextran)in a single-cell layer model.Neutrophil infiltration in the brain tissue,inflammatory cytokine levels in the serum,neurological function,and 7-day survival rates were used to evaluate therapeutic eff ects of mannitol and vancomycin in MRSA-infected rats.Syndecan-1 and fi lamentous actin(F-actin) levels were measured,and the relationship between F-actin and the endothelial glycocalyx layer(EGL) was explored via the depolymerization agent cytochalasin D and the polymerization agent jasplakinolide.RESULTS:Following mannitol administration,the NaF and vancomycin concentrations in the brain tissue increased rapidly within 5 min and remained stable for 30 min,indicating that mannitol increased BBB permeability for 30 min.In vitro,mannitol treatment led to significantly greater FITC-dextran permeation through a single-cell layer compared to controls.In the MRSA intracranial infection model,rats treated with mannitol and vancomycin simultaneously presented less infl ammation,improved neurological function,and increased 7-day survival rate compared to rats treated with vancomycin and mannitol at 10-hour intervals.Further experiments revealed that mannitol decreased the expression of syndecan-1 in brain tissues,which was confi rmed by in vitro experiments showing that mannitol signifi cantly decreased syndecan-1 via F-actin depolymerization.CONCLUSION:Mannitol may enhance the therapeutic effi cacy of vancomycin against intracranial MRSA infection by decreasing the endothelial glycocalyx of the BBB via F-actin depolymerization.展开更多
BACKGROUND Plasma concentration monitoring is crucial for optimizing vancomycin use,particularly in patients in the intensive care unit(ICU).However,the reference interval for vancomycin plasma concentration remains u...BACKGROUND Plasma concentration monitoring is crucial for optimizing vancomycin use,particularly in patients in the intensive care unit(ICU).However,the reference interval for vancomycin plasma concentration remains undetermined.AIM To evaluate the correlations of area under the curve(AUC_(0-24))and trough concentration(C_(min))with efficacy and nephrotoxicity in patients in the ICU.METHODS A total of 103 patients treated with vancomycin for methicillin-resistant Staphylococcus aureus infections were analyzed in this study.The associations of clinicodemographic characteristics(including sex,age,weight,infection sites,main etiologies of ICU cases,comorbidities,acute physiological chronic health evaluation II score,and mechanical ventilation)and pharmacokinetics(daily dose,C_(min),AUC_(0-24),and AUC_(0-24)/minimum inhibitory concentration)with efficacy and nephrotoxicity of vancomycin were evaluated with univariate and multivariate logistic regression analyses.AUC_(0-24)was calculated using VCM-TDM software based on vancomycin population pharmacokinetics and Bayesian feedback method.RESULTS Cmin over 9.4μg/mL and AUC_(0-24)exceeding 359.6μg×hour/mL indicated good efficacy against infection.Cmin below 14.0μg/mL predicted no significant nephrotoxicity.CONCLUSION In this study,the effective and safe concentration interval for vancomycin in patients in the ICU was Cmin 9.4-14.0μg/mL.Close attention should be paid to adverse effects and renal function during vancomycin treatment.展开更多
Staphylococcus aureus(SA) infections remain a major cause of morbidity and mortality despite the availability of numerous effective anti-staphylococcal antibiotics.This organism is responsible for both nosocomial and ...Staphylococcus aureus(SA) infections remain a major cause of morbidity and mortality despite the availability of numerous effective anti-staphylococcal antibiotics.This organism is responsible for both nosocomial and community-acquired infections ranging from relatively minor skin and soft tissue infections to life-threateningsystemic infections.The increasing incidence of methicillin-resistant strains has granted an increasing use of vancomycin causing a covert progressive increase of its minimum inhibitory concentration(MIC)(dubbed the MIC "creep").In this way,the emergence of vancomycinintermediate SA(VISA) strains and heteroresistantVISA has raised concern for the scarcity of alternative treatment options.Equally alarming,though fortunately less frequent,is the emergence of vancomycin-resistant SA.These strains show different mechanisms of resistance but have similar problems in terms of therapeutic approach.Ultimately,various debate issues have arisen regarding the emergence of SA strains with a minimum inhibitory concentration sitting on the superior limit of the sensitivity range(i.e.,MIC = 2 μg/mL).These strains have shown certain resilience to vancomycin and a different clinical behaviour regardless of vancomycin use,both in methicillin-resistant SA and in methicillin-sensitive SA.The aim of this text is to revise the clinical impact and consequences of the emergence of reduced vancomycin susceptibility SA strains,and the different optimal treatment options known.展开更多
To compare the efficacy and safety of fidaxomicin and vancomycin for the treatment of patients with Clostridium difficile infection （CD1）, randomized controlled trials （RCTs） of fidaxomicin versus vancomycin for t...To compare the efficacy and safety of fidaxomicin and vancomycin for the treatment of patients with Clostridium difficile infection （CD1）, randomized controlled trials （RCTs） of fidaxomicin versus vancomycin for the treatment of CDI published in Pubmed, Embase, Web of Science and the Cochrane library were searched. Two reviewers independently extracted the data. The primary outcome was the rates of clinical cure. The secondary endpoints were the rates of CDI recurrence in the 4 weeks period after the end of therapy and rates of global cure, adverse events. Meta-analysis was performed using the Mantle-Haenszel fixed effect method （FEM）. Odds ratios （ORs） with 95% confidence intervals （95% CIs） were reported. The results indicated that two large randomized controlled trials were included in the meta-analysis. Clinical cure with fidaxomicin was similar to with vancomycin both in the modified intention to treat （OR = 1.17, 95% CI 0.82-1.66, P = 0.40） and in the per-protocol population （OR = 1.24, 95% CI 0.80-1.92, P = 0.34）. There were no significant differences in the rates of clinical cure between fidaxomicin and vancomycin in the subgroups analyzed by age, patients＇ status, and previous CDI, infection with B 1 strain, severity baseline, and exposure to concomitant antibiotics. Recurrence of CDI was significantly less common among fidaxomicin-treated patients compared with vancomycin-treated patients both in the modified intention-to-treat population （OR = 0.47, 95% CI 0.34-0.65, P〈0.00001） and in the per-protocol population （OR = 0.45, 95% CI 0.31-0.62, P〈0.0001）. Treatment with fidaxomicin compared with vancomycin was associated with significantly higher rates of global cure both in the modifed intention-to-treat population （OR = 1.75, 95% CI 1.35-2.27, P〈0.0001） and in the per-protocol population （OR = 1.86, 95% CI 1.40-2.47, P〈0.0001）. Our recta-analysis suggests that fidaxomicin is not superior to vancomycin in rates of clinical cure, while fidaxomicin significantly decreases the rates of CDI recurrence and significantly improves the rates of global cure compared with vancomycin. Thus, fidaxomicin is a promising candidate for treatment of the CDI, especially in decreasing the rates of CDI recurrence and improving the rates of global cure.展开更多
In the present study, clinical pharmacists monitored the blood concentration of vancomycin in children in the Infant Ward from 2013 to 2014, and the drug dose was adjusted according to its plasma concentration. Moreov...In the present study, clinical pharmacists monitored the blood concentration of vancomycin in children in the Infant Ward from 2013 to 2014, and the drug dose was adjusted according to its plasma concentration. Moreover, we analyzed the plasma concentration of vancomycin in infants in the hospital from 2013 to 2014. Simultaneously, we also discussed the necessity of regular therapeutic drug monitoring of vancomycin in infants, and the important role of clinical pharmacists was further explored. The results showed that it was necessary to routinely monitor the therapeutic drug in infants. Clinical pharmacists performed medication monitoring, which improved the effectiveness of vancomycin and prevented its adverse effects. In addition, it is a new treatment model for the participation of clinical pharmacists in the clinical treatment.展开更多
BACKGROUND Vancomycin flushing syndrome(VFS),also known as red man syndrome,is an allergic reaction to vancomycin.It typically presents as a rash on the face,neck,and upper torso after intravenous administration of va...BACKGROUND Vancomycin flushing syndrome(VFS),also known as red man syndrome,is an allergic reaction to vancomycin.It typically presents as a rash on the face,neck,and upper torso after intravenous administration of vancomycin.VFS is blamed on rapid intravenous infusion of vancomycin during management and rarely happens after local use.A review of the literature showed that in the last 23 years,4 such cases have been reported.Here,we add another case of VFS developed after slow local absorption of vancomycin in cement beads.CASE SUMMARY A 44-year-old male with a known case of hypertension,no history of allergies to medications,and a history of chronic osteomyelitis of the right tibia with discharging sinus over the anterolateral aspect of the leg.The pus culture grew Staphylococcus aureus,which was sensitive to clindamycin and vancomycin.The patient underwent irrigation and debridement with the placement of vancomycin cement beads made from 4 g of vancomycin powder and 40 g of polymethyl methacrylate.Three hours postoperatively,the patient developed a pruritic,erythematous,macular rash predominantly on his face,neck,chest,and lower extremities and to a lesser extent his upper extremities.A diagnosis of VFS was made and was successfully treated with cetirizine(10 mg,oral)and methylprednisolone sodium succinate(125 mg,intravenous).The patient continued to have itching with a facial rash for 12 h with gradual improvement.A decision was made to not remove the beads as the patient continued to improve.Gradually,the rash disappeared after 96 h with no further sequela.CONCLUSION VFS can occur not only after rapid intravenous injection of vancomycin but also with local release,as in our case.As orthopaedic surgeons routinely use vancomycin with polymethyl methacrylate in chronic osteomyelitis and revision arthroplasty,they should be aware of such a complication occurring.展开更多
Objective:To investigate the relation between fruit seeds,plants residuals and appendicitis. Methods:Among cases that underwent appendectomy,the appendicitis cases having fruit seeds and undigested plant residuals in ...Objective:To investigate the relation between fruit seeds,plants residuals and appendicitis. Methods:Among cases that underwent appendectomy,the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively.Also, histopathological features,age,sex,and parameters of morbidity and mortality were used. Results:Fruit seed was found in one case(0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases(0.35%).It was determined that there were appendix inflammation in 2 of the plant residuals cases,while there were obstruction and lymphoid hyperplasia in the appendix lumen of 5 cases.No mortality was observed.Conclusions:The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.展开更多
Clinical guidelines recommend a steady-state vancomycin(VCM)trough concentration(SVTC)of 10–15 mg/L for regular infections and 15–20 mg/L for severe infections.However,clinical trials have shown that increasing SVTC...Clinical guidelines recommend a steady-state vancomycin(VCM)trough concentration(SVTC)of 10–15 mg/L for regular infections and 15–20 mg/L for severe infections.However,clinical trials have shown that increasing SVTC is not beneficial for efficacy,and instead it leads to nephrotoxicity.To verify whether increasing the SVTC results in improved clinical outcomes with sustainable adverse effects,we prospectively determined its correlation with clinical efficacy and safety.The participants included patients hospitalized with Gram-positive bacterial infections from March 2017 through October 2018.The patients were classified into group I(SVTC<10 mg/L),II(10≤SVTC≤20 mg/L),or III(SVTC>20 mg/L).Clinical,microbiological,and laboratory data were collected.Clinical outcomes between group I and II were matched after propensity score matching(PSM).A total of 331 patients were included in this study.Clinical failure occurred in 59(29%)of 204 patients on day 14,with no significant difference between groups I and II(P=0.535).Infection recurred at 28 d in 62(30%)of 204 patients,and no significant difference in infection recurrence was observed between both the groups(log-rank,P=0.674).Except for a significant increase in the incidence of acute kidney injury in group II,no significant difference was observed between two groups for any clinical results.The incidence of adverse events in groups I and II was significantly lower than that in group III(P<0.001).SVTC had an applicable cut-off point at 14.55 mg/L.SVTC was not correlated with VCM clinical efficacy,while it was a good indicator of nephrotoxicity.展开更多
Objective This study aimed to evaluate the clinical benefits of a vancomycin dosage strategy based on a serum trough concentration model in elderly patients.Methods This prospective single-center, open-label, randomiz...Objective This study aimed to evaluate the clinical benefits of a vancomycin dosage strategy based on a serum trough concentration model in elderly patients.Methods This prospective single-center, open-label, randomized controlled trial categorized 66 elderly patients with severe pneumonia into study and control groups. The control group received vancomycin using a regimen decided by the attending physician. Meanwhile, the study group received individualized vancomycin therapy with a dosing strategy based on a serum trough concentration model. The primary endpoint was the proportion of patients with serum trough concentrations reaching the target values.The secondary endpoints were clinical response, vancomycin treatment duration, and vancomycinassociated acute kidney injury(VA-AKI) occurrence.Results All patients were at least 60 years old(median age = 81 years). The proportion of patients with target trough concentration achievement(≥ 15 mg/L) with the initial vancomycin regimen was significantly higher in the study group compared to the control group(75.8% vs. 42.4%, P = 0.006).Forty-five patients(68.2%) achieved clinical success, the median duration of vancomycin therapy was10.0 days, and VA-AKI occurred in eight patients(12.1%). However, there were no significant differences in these parameters between the two groups. The model for predicting vancomycin trough concentrations was upgraded to: serum trough concentration(mg/L) = 17.194-0.104 × creatinine clearance rate(mL/min) + 0.313 × vancomycin daily dose [mg/(kg·d)].Conclusion A vancomycin dosage strategy based on a serum trough concentration model can improve the proportion of patients achieving target trough concentrations in elderly patients with severe pneumonia.展开更多
Vancomycin hydrochloride(VANH),the first glycopeptide antibiotic,is a water-soluble drug for the treatment of acute osteomyelitis.Liposomal formulations of VANH have already been manipulated and characterized,which wa...Vancomycin hydrochloride(VANH),the first glycopeptide antibiotic,is a water-soluble drug for the treatment of acute osteomyelitis.Liposomal formulations of VANH have already been manipulated and characterized,which was a mean of increasing their therapeutic index,reducing their toxicity and altering drug biodistribution.One of the challenges for preparing VANH-Lips is their low encapsulation efficiency(EE).In the present study,we aim to improve the liposomal formulation of VANH for higher EE,longer systemic circulation,reduced nephrotoxicity and enhanced antimicrobial activities.Vancomycin hydrochloride-loaded liposomes(VANH-Lips)were formulated by the method of modified reverse phase evaporation.Based on the optimization of formulation with orthogonal experimental design,the average drug encapsulation efficiency and the mean particle size of VANH-Lips were found to be 40.78±2.56%and 188.4±2.77 nm.In vitro drug release of VANH-Lips possessed a sustained release characteristic and their release behavior was in accordance with the Weibull equation.After intravenous injection to mice,the mean residence time(MRT)of VANH-Lips group was significantly prolonged in vivo and the AUC value was improved as well compared with the vancomycin hydrochloride solution(VANH-Sol)group.Furthermore,the biodistribution results in mice showed that VANH-Lips decreased the accumulation of VANH in kidney after intravenous injection.In conclusion,VANH-Lips may be a potential delivery system for VANH to decrease nephrotoxicity in the treatment of osteomyelitis.展开更多
Current trends in chiral analysis of pharmaceutical drugs are focused on faster separations and higher separation efficiencies, Core-shell or superficially porous particles （SPP） based chiral stationary phases （CSP...Current trends in chiral analysis of pharmaceutical drugs are focused on faster separations and higher separation efficiencies, Core-shell or superficially porous particles （SPP） based chiral stationary phases （CSPs） provide reduced analysis times while maintaining high column efficiencies and sensitivity. In this study, mobile phase conditions suitable for chiral analyses with electrospray ionization LC-MS were systematically investigated using vancomycin as a representative CSP. The performance of a 2.7 μm SPP based vancomycin CSP （SPP-V） 10 cm ×0.21 cm column was compared to that of a corresponding 5 μm fully porous particles based analogue column. The results demonstrated that the SPP-V column provides higher efficiencies, 2-5 time greater sensitivity and shorter analysis time for a set of 22 basic pharma- ceutical drugs. The SPP-V was successfully applied for the analysis of the degradation products of racemic citalopram whose enantiomers could be selectively identified by MS.展开更多
AIMTo investigate the incidence and risk factors for van-comycin concentrations less than 10 mg/L during cardiac surgery.METHODSIn this prospective study, patients undergoing cardiac surgery received a single dose of ...AIMTo investigate the incidence and risk factors for van-comycin concentrations less than 10 mg/L during cardiac surgery.METHODSIn this prospective study, patients undergoing cardiac surgery received a single dose of 1000 mg of van-comycin. Multiple arterial samples were drawn during surgery. Exclusion criteria were hepatic dysfunction; renal dysfunction; ongoing infectious diseases; solid or hematologic tumors; severe insulin-dependent diabetes; body mass index of 〈 17 or 〉 40 kg/m2; pregnancy or lactation; antibiotic, corticosteroid, orother immunosuppressive therapy; vancomycin or non-steroidal anti-inflammatory drug therapy in the previous2 wk; chemotherapy or radiation therapy in the previous 6 mo; allergy to vancomycin or cefazolin; drug abuse; cardiac surgery in the previous 6 mo; previous or scheduled organ transplantation; preoperative stay in the intensive care unit for more than 24 h; emergency procedure or lack of adequate preparation for surgery; and participation in another trial.RESULTSOver a 1-year period, 236 patients were enrolled, and a total of 1682 serum vancomycin concentrations （median 7/patient） were measured. No vancomycin levels under 10 mg/L were recorded in 122 out of 236 patients （52%）, and 114 out of 236 patients （48%） were found to have at least 1 serum sample with a vancomycin level 〈 10 mg/L; 54 out of 236 patients （22.9%） had at least 5 serum samples with a vancomycin level lower than 10 mg/L. Vancomycin infusion was administered for 60 min in 97 out of 236 patients （41%）. In 47 patients （20%）, the duration of infusion was longer than 60 min, and in 92 patients （39%） the duration of infusion was shorter than 60 min. The maximum concentration and area under the concentration-time curve were significantly higher in patients with no vancomycin levels less than 10 mg/L （ P 〈 0.001）. The multivariate analysis identifiedfemale gender, body mass index （BMI） 〉 25 kg/m , and creatinine clearance above 70 mL/min as risk factors for vancomycin levels less than 10 mg/L.CONCLUSIONResults of this study identified female gender, BMI 〉 25 kg/m2, and creatinine clearance above 70 mL/min as risk factors for suboptimal vancomycin serum concentration during cardiac surgery; no relationship was found bet-ween infusion duration and vancomycin levels less than 10 mg/L. These findings call attention to the risk of facilitating the emergence of vancomycin-resistant methicillin-resistant Staphylococcus aureus strains.展开更多
BACKGROUND Vancomycin and teicoplanin are both antibiotics that have significant antimicrobial effects on Gram-positive cocci.AIM To explore the value of teicoplanin combined with conventional(vancomycin only)anti-inf...BACKGROUND Vancomycin and teicoplanin are both antibiotics that have significant antimicrobial effects on Gram-positive cocci.AIM To explore the value of teicoplanin combined with conventional(vancomycin only)anti-infective therapy for the treatment of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis pulmonary infections.METHODS A total of 86 patients with methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis pulmonary infections,treated in our hospital between January 2018 and February 2020,were assigned to the study and control groups using a random number table method,with 43 patients in each group.The control group received conventional treatment(vancomycin),and the study group received both teicoplanin and conventional treatment.The following indicators were assessed in both groups:the time required for symptom relief,treatment effectiveness,serum levels of inflammatory factors(procalcitonin,interleukin-1β,tumor necrosis factor-α,C-reactive protein),clinical pulmonary infection scores before and after treatment,and the incidence of adverse reactions.RESULTS Patients in the study group were observed to have faster cough and expectoration resolution,white blood cell count normalization,body temperature normalization,and rales disappearance than patients in the control group(all P<0.05);the total rate of effectiveness was 93.02%in the study group,higher than the 76.74%in the control group(P<0.05).The pre-treatment serum levels of procalcitonin,interleukin-1β,tumor necrosis factor-α,and C-reactive protein as well as the clinical pulmonary infection scores were similar among the patients in both groups.However,the post-treatment serum levels of procalcitonin,interleukin-1β,tumor necrosis factor-α,and C-reactive protein as well as the clinical pulmonary infection scores were significantly lower in the study group than in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the groups.CONCLUSION Compared with conventional(vancomycin only)therapy,teicoplanin and vancomycin combination therapy for patients with pulmonary methicillinresistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis infections can improve patient clinical symptoms,modulate serum inflammatory factor levels,and improve treatment efficacy,without increasing the risk of adverse reactions.展开更多
BACKGROUND Thrombocytopenia is a serious complication in the medical practice of numerous drugs.Vancomycin is frequently used for the prophylaxis and treatment of suspected or identified methicillin-resistant positive...BACKGROUND Thrombocytopenia is a serious complication in the medical practice of numerous drugs.Vancomycin is frequently used for the prophylaxis and treatment of suspected or identified methicillin-resistant positive infections.Several cases with vancomycin-induced thrombocytopenia(VIT)have been reported.However,these have rarely been extensively reviewed.The present report describes a case of VIT in endocarditis,and reviews all VIT cases reported in the literature.CASE SUMMARY A 26-year-old male diagnosed with infective endocarditis was admitted.The patient was treated with multiple drugs,including vancomycin,which was initially intravenously given at 1000 mg every 12 h and subsequently at 500 mg every 8 h on day 3.On day 11,the platelet count decreased to 51×10^(9)/L,vancomycin was switched to 500 mg every 12 h,and platelet transfusion was given.On day 17,the platelet count dropped to 27×10^(9)/L,and platelet transfusion was administered again.On day 23,vancomycin was adjusted to 500 mg every 8 h as the trough concentration dropped to the minimum effective concentration.On day 33,the platelet count declined to approximately 40×10^(9)/L.After platelet transfusion,the platelet count rebounded to 90×10^(9)/L on day 35 but dropped again to 42×10^(9)/L on day 43.Based on the time-to-platelet count curve and Naranjo’s Adverse Drug Reaction Probability Scale score,VIT was suspected.After vancomycin discontinuation and platelet transfusion,the platelet count gradually normalized.CONCLUSION The diagnosis of VIT can be achieved through the time-to-platelet count curve and Naranjo’s Adverse Drug Reaction Probability Scale score.The platelet count cannot be normalized simply by platelet transfusion alone,and vancomycin discontinuation is essential.展开更多
A series of biodegradable hydrogels based on dextran and poly（L-glutamic acid） were fabricated for effective vancomycin loading and release. The preparation of hydrogels was simply achieved by photo cross-linking of...A series of biodegradable hydrogels based on dextran and poly（L-glutamic acid） were fabricated for effective vancomycin loading and release. The preparation of hydrogels was simply achieved by photo cross-linking of methacrylated dextran and poly（L-glutamic acid）-g-hydroxyethyl methacrylate （PGH） in the presence of photoinitiator 12959. The structures of hydrogels were characterized by FTIR and SEM. The swelling and enzymatic degradation behaviors of hydrogels were examined to be dependent on the poly（L-glutamic acid） content in the hydrogels. The higher content of poly（L-glutamic acid） in the gel, the higher swelling ratio and quicker degradation were observed. More interestingly, the hydrogel with higher PGH ratio showed higher vancomycin （VCM） loading content, which might be due to the electrostatic interaction between carboxylate groups in hydrogel and ammonium group of VCM. In vitro drug release from the VCM-loaded hydrogels in aqueous solution exhibited sustained release of VCM up to 72 h, while the in vitro antibacterial test based on the VCM-loaded hydrogel showed an efficient Methicillin-Resistant S. aureus （MRSA） inhibition extending out to 7 days. These results demonstrated that the biodegradable hydrogels which formed by in situ photo-cross linking would be promising as scaffolds or coatings for local antibacterial drug release in tissue engineering.展开更多
This study aimed to develop a guideline for therapeutic drug monitoring（TDM） of vancomycin. We adopted the new guideline definition from the Institute of Medicine（IOM）, adhered closely to the six domains of the Ap...This study aimed to develop a guideline for therapeutic drug monitoring（TDM） of vancomycin. We adopted the new guideline definition from the Institute of Medicine（IOM）, adhered closely to the six domains of the Appraisal of Guidelines for Research ＆ Evaluation Ⅱ（AGREE Ⅱ）, and made recommendations based on systematic reviews. We established a Guideline Steering Group and a Guideline Development Group, formulated 12 questions in the form of Population, Intervention, Comparison, Outcome（PICO） and completed a literature search. As far as we know, we will develop the first evidenced-based guideline for vancomycin TDM under the framework of the Grade of Recommendations Assessment, Development and Evaluation（GRADE）.展开更多
Liver injury caused by acetaminophen(AP)overdose is a leading public health problem.Although APinduced liver injury is well recognized as the formation of N-acetyl-p-benzoquinone(NAPQI),a toxic metabolite of AP,result...Liver injury caused by acetaminophen(AP)overdose is a leading public health problem.Although APinduced liver injury is well recognized as the formation of N-acetyl-p-benzoquinone(NAPQI),a toxic metabolite of AP,resulting in cell damage,emerging evidence indicates that AP-induced liver injury is also associated with gut microbiota.However,the gut microbiota-involved mechanism remains largely unknown.In our study,we found that vancomycin(Vac)pretreatment(100 mg/kg,twice a day for 4 days)attenuated AP-induced liver injury,altered the composition of gut microbiota,and changed serum metabolic profile.Moreover,we identified Vac pretreatment elevated cecum and serum 2-hydroxybutyric acid(2-HB),which ameliorated AP-induced cell damage and liver injury in mice by reducing AP bioavailability and elevating GSH levels.Our current results revealed the novel role of 2-HB in protecting AP-induced liver injury and add new evidence for gut microbiota in affecting AP toxicity.展开更多
In the present study, we aimed to develop a population pharmacokinetics(PPK) model of vancomycin(VCM) and propose the individualised dosage regimen for Chinese elderly patients. The data were collected prospectively f...In the present study, we aimed to develop a population pharmacokinetics(PPK) model of vancomycin(VCM) and propose the individualised dosage regimen for Chinese elderly patients. The data were collected prospectively from Chinese elderly patients receiving VCM therapy. Steady-state trough concentrations of VCM were determined using an enzyme-multiplied immunoassay. Patients’ sex, age, body weight, concomitant medications, infection type, and laboratory findings were recorded. The PPK model was developed using nonlinear mixed-effects model software. Moreover, we used Monte Carlo simulations to develop an initial dosage regimen targeting various VCM through concentration ranges based on the final model. We found that VCM clearance(CL) was significantly influenced by post-craniotomy meningitis(PCM) and glomerular filtration rate in elderly patients. Additionally, a new dosage regimen was proposed to individualise VCM regimen for PCM and non-PCM elderly patients. A PPK model was established to estimate the individual VCM CL for elderly patients, which could be applied for individualising doses in the target population.展开更多
BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg...BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.展开更多
Vancomycin-resistant Enterococcus faecalis pose an emerging health risk, but little is known about the precise epidemiology for vancomycin resistance. The glycopeptide resistant was studied using different techniques ...Vancomycin-resistant Enterococcus faecalis pose an emerging health risk, but little is known about the precise epidemiology for vancomycin resistance. The glycopeptide resistant was studied using different techniques such as broth macrodilution, agar dilution combined with agar diffusion, morphology cell changes by scanning electron microscopy. Eight VREF isolated from different clinical samples were used. Results showed low level and high level resistant to vancomycin antibiotic at concentration of 64 to 128 μg/ml, but antibacterial activity was reduced to 256 μg/ml, the SEM revaled increased in the cell size with the antibiotic compared to control and standard culture. The technique constitutes simple method for the detection of organism.展开更多
基金supported by the National Natural Science Foundation for Young Scientists of China (grant no.2002074)the Natural Science Foundation of Guangdong Province(2023A1515010267, 2023A1515012665, 2024A1515010073)+1 种基金the China International Medical Foundation Cerebrovascular Disease Youth Innovation Fund (Z-2016-20-2201)the Medical Leading Talents Fund of Guangdong Province (KJ012019430)。
文摘BACKGROUND:The present study aims to investigate whether mannitol facilitates central nervous system(CNS) entry of vancomycin and alleviates methicillin-resistant Staphylococcus aureus(MRSA)intracranial infection.METHODS:Blood-brain barrier(BBB) permeability was assessed by measuring the concentration of sodium fl uorescein(NaF) in the brain tissues of rats and fl uorescein isothiocyanate-dextran(FITC-dextran)in a single-cell layer model.Neutrophil infiltration in the brain tissue,inflammatory cytokine levels in the serum,neurological function,and 7-day survival rates were used to evaluate therapeutic eff ects of mannitol and vancomycin in MRSA-infected rats.Syndecan-1 and fi lamentous actin(F-actin) levels were measured,and the relationship between F-actin and the endothelial glycocalyx layer(EGL) was explored via the depolymerization agent cytochalasin D and the polymerization agent jasplakinolide.RESULTS:Following mannitol administration,the NaF and vancomycin concentrations in the brain tissue increased rapidly within 5 min and remained stable for 30 min,indicating that mannitol increased BBB permeability for 30 min.In vitro,mannitol treatment led to significantly greater FITC-dextran permeation through a single-cell layer compared to controls.In the MRSA intracranial infection model,rats treated with mannitol and vancomycin simultaneously presented less infl ammation,improved neurological function,and increased 7-day survival rate compared to rats treated with vancomycin and mannitol at 10-hour intervals.Further experiments revealed that mannitol decreased the expression of syndecan-1 in brain tissues,which was confi rmed by in vitro experiments showing that mannitol signifi cantly decreased syndecan-1 via F-actin depolymerization.CONCLUSION:Mannitol may enhance the therapeutic effi cacy of vancomycin against intracranial MRSA infection by decreasing the endothelial glycocalyx of the BBB via F-actin depolymerization.
基金Supported by the Key Project Plan of Health and Medical Science Research in Hebei Provincial Health Commission,No.20190745.
文摘BACKGROUND Plasma concentration monitoring is crucial for optimizing vancomycin use,particularly in patients in the intensive care unit(ICU).However,the reference interval for vancomycin plasma concentration remains undetermined.AIM To evaluate the correlations of area under the curve(AUC_(0-24))and trough concentration(C_(min))with efficacy and nephrotoxicity in patients in the ICU.METHODS A total of 103 patients treated with vancomycin for methicillin-resistant Staphylococcus aureus infections were analyzed in this study.The associations of clinicodemographic characteristics(including sex,age,weight,infection sites,main etiologies of ICU cases,comorbidities,acute physiological chronic health evaluation II score,and mechanical ventilation)and pharmacokinetics(daily dose,C_(min),AUC_(0-24),and AUC_(0-24)/minimum inhibitory concentration)with efficacy and nephrotoxicity of vancomycin were evaluated with univariate and multivariate logistic regression analyses.AUC_(0-24)was calculated using VCM-TDM software based on vancomycin population pharmacokinetics and Bayesian feedback method.RESULTS Cmin over 9.4μg/mL and AUC_(0-24)exceeding 359.6μg×hour/mL indicated good efficacy against infection.Cmin below 14.0μg/mL predicted no significant nephrotoxicity.CONCLUSION In this study,the effective and safe concentration interval for vancomycin in patients in the ICU was Cmin 9.4-14.0μg/mL.Close attention should be paid to adverse effects and renal function during vancomycin treatment.
文摘Staphylococcus aureus(SA) infections remain a major cause of morbidity and mortality despite the availability of numerous effective anti-staphylococcal antibiotics.This organism is responsible for both nosocomial and community-acquired infections ranging from relatively minor skin and soft tissue infections to life-threateningsystemic infections.The increasing incidence of methicillin-resistant strains has granted an increasing use of vancomycin causing a covert progressive increase of its minimum inhibitory concentration(MIC)(dubbed the MIC "creep").In this way,the emergence of vancomycinintermediate SA(VISA) strains and heteroresistantVISA has raised concern for the scarcity of alternative treatment options.Equally alarming,though fortunately less frequent,is the emergence of vancomycin-resistant SA.These strains show different mechanisms of resistance but have similar problems in terms of therapeutic approach.Ultimately,various debate issues have arisen regarding the emergence of SA strains with a minimum inhibitory concentration sitting on the superior limit of the sensitivity range(i.e.,MIC = 2 μg/mL).These strains have shown certain resilience to vancomycin and a different clinical behaviour regardless of vancomycin use,both in methicillin-resistant SA and in methicillin-sensitive SA.The aim of this text is to revise the clinical impact and consequences of the emergence of reduced vancomycin susceptibility SA strains,and the different optimal treatment options known.
文摘To compare the efficacy and safety of fidaxomicin and vancomycin for the treatment of patients with Clostridium difficile infection （CD1）, randomized controlled trials （RCTs） of fidaxomicin versus vancomycin for the treatment of CDI published in Pubmed, Embase, Web of Science and the Cochrane library were searched. Two reviewers independently extracted the data. The primary outcome was the rates of clinical cure. The secondary endpoints were the rates of CDI recurrence in the 4 weeks period after the end of therapy and rates of global cure, adverse events. Meta-analysis was performed using the Mantle-Haenszel fixed effect method （FEM）. Odds ratios （ORs） with 95% confidence intervals （95% CIs） were reported. The results indicated that two large randomized controlled trials were included in the meta-analysis. Clinical cure with fidaxomicin was similar to with vancomycin both in the modified intention to treat （OR = 1.17, 95% CI 0.82-1.66, P = 0.40） and in the per-protocol population （OR = 1.24, 95% CI 0.80-1.92, P = 0.34）. There were no significant differences in the rates of clinical cure between fidaxomicin and vancomycin in the subgroups analyzed by age, patients＇ status, and previous CDI, infection with B 1 strain, severity baseline, and exposure to concomitant antibiotics. Recurrence of CDI was significantly less common among fidaxomicin-treated patients compared with vancomycin-treated patients both in the modified intention-to-treat population （OR = 0.47, 95% CI 0.34-0.65, P〈0.00001） and in the per-protocol population （OR = 0.45, 95% CI 0.31-0.62, P〈0.0001）. Treatment with fidaxomicin compared with vancomycin was associated with significantly higher rates of global cure both in the modifed intention-to-treat population （OR = 1.75, 95% CI 1.35-2.27, P〈0.0001） and in the per-protocol population （OR = 1.86, 95% CI 1.40-2.47, P〈0.0001）. Our recta-analysis suggests that fidaxomicin is not superior to vancomycin in rates of clinical cure, while fidaxomicin significantly decreases the rates of CDI recurrence and significantly improves the rates of global cure compared with vancomycin. Thus, fidaxomicin is a promising candidate for treatment of the CDI, especially in decreasing the rates of CDI recurrence and improving the rates of global cure.
基金Shanghai Outstanding Young University Teachers Research and Special Funds(Grant No.ZZjdyx13089)Science and Technology Commission of Shanghai Municipality Grants(Grant No.12DZ1930404)
文摘In the present study, clinical pharmacists monitored the blood concentration of vancomycin in children in the Infant Ward from 2013 to 2014, and the drug dose was adjusted according to its plasma concentration. Moreover, we analyzed the plasma concentration of vancomycin in infants in the hospital from 2013 to 2014. Simultaneously, we also discussed the necessity of regular therapeutic drug monitoring of vancomycin in infants, and the important role of clinical pharmacists was further explored. The results showed that it was necessary to routinely monitor the therapeutic drug in infants. Clinical pharmacists performed medication monitoring, which improved the effectiveness of vancomycin and prevented its adverse effects. In addition, it is a new treatment model for the participation of clinical pharmacists in the clinical treatment.
文摘BACKGROUND Vancomycin flushing syndrome(VFS),also known as red man syndrome,is an allergic reaction to vancomycin.It typically presents as a rash on the face,neck,and upper torso after intravenous administration of vancomycin.VFS is blamed on rapid intravenous infusion of vancomycin during management and rarely happens after local use.A review of the literature showed that in the last 23 years,4 such cases have been reported.Here,we add another case of VFS developed after slow local absorption of vancomycin in cement beads.CASE SUMMARY A 44-year-old male with a known case of hypertension,no history of allergies to medications,and a history of chronic osteomyelitis of the right tibia with discharging sinus over the anterolateral aspect of the leg.The pus culture grew Staphylococcus aureus,which was sensitive to clindamycin and vancomycin.The patient underwent irrigation and debridement with the placement of vancomycin cement beads made from 4 g of vancomycin powder and 40 g of polymethyl methacrylate.Three hours postoperatively,the patient developed a pruritic,erythematous,macular rash predominantly on his face,neck,chest,and lower extremities and to a lesser extent his upper extremities.A diagnosis of VFS was made and was successfully treated with cetirizine(10 mg,oral)and methylprednisolone sodium succinate(125 mg,intravenous).The patient continued to have itching with a facial rash for 12 h with gradual improvement.A decision was made to not remove the beads as the patient continued to improve.Gradually,the rash disappeared after 96 h with no further sequela.CONCLUSION VFS can occur not only after rapid intravenous injection of vancomycin but also with local release,as in our case.As orthopaedic surgeons routinely use vancomycin with polymethyl methacrylate in chronic osteomyelitis and revision arthroplasty,they should be aware of such a complication occurring.
基金Supported by the Department of Biotechnology.Government of India
文摘Objective:To investigate the relation between fruit seeds,plants residuals and appendicitis. Methods:Among cases that underwent appendectomy,the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively.Also, histopathological features,age,sex,and parameters of morbidity and mortality were used. Results:Fruit seed was found in one case(0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases(0.35%).It was determined that there were appendix inflammation in 2 of the plant residuals cases,while there were obstruction and lymphoid hyperplasia in the appendix lumen of 5 cases.No mortality was observed.Conclusions:The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.
基金Fujian Medical Innovation Project(Grant No.2017-CX-31)Guidance Project of Fujian Science and Technology Department(Grant No.2017Y0033).
文摘Clinical guidelines recommend a steady-state vancomycin(VCM)trough concentration(SVTC)of 10–15 mg/L for regular infections and 15–20 mg/L for severe infections.However,clinical trials have shown that increasing SVTC is not beneficial for efficacy,and instead it leads to nephrotoxicity.To verify whether increasing the SVTC results in improved clinical outcomes with sustainable adverse effects,we prospectively determined its correlation with clinical efficacy and safety.The participants included patients hospitalized with Gram-positive bacterial infections from March 2017 through October 2018.The patients were classified into group I(SVTC<10 mg/L),II(10≤SVTC≤20 mg/L),or III(SVTC>20 mg/L).Clinical,microbiological,and laboratory data were collected.Clinical outcomes between group I and II were matched after propensity score matching(PSM).A total of 331 patients were included in this study.Clinical failure occurred in 59(29%)of 204 patients on day 14,with no significant difference between groups I and II(P=0.535).Infection recurred at 28 d in 62(30%)of 204 patients,and no significant difference in infection recurrence was observed between both the groups(log-rank,P=0.674).Except for a significant increase in the incidence of acute kidney injury in group II,no significant difference was observed between two groups for any clinical results.The incidence of adverse events in groups I and II was significantly lower than that in group III(P<0.001).SVTC had an applicable cut-off point at 14.55 mg/L.SVTC was not correlated with VCM clinical efficacy,while it was a good indicator of nephrotoxicity.
基金funded as a key clinical project of Peking University Third Hospital [No. BYSY2018021]funded by Beijing Natural Science Foundation [7212128]。
文摘Objective This study aimed to evaluate the clinical benefits of a vancomycin dosage strategy based on a serum trough concentration model in elderly patients.Methods This prospective single-center, open-label, randomized controlled trial categorized 66 elderly patients with severe pneumonia into study and control groups. The control group received vancomycin using a regimen decided by the attending physician. Meanwhile, the study group received individualized vancomycin therapy with a dosing strategy based on a serum trough concentration model. The primary endpoint was the proportion of patients with serum trough concentrations reaching the target values.The secondary endpoints were clinical response, vancomycin treatment duration, and vancomycinassociated acute kidney injury(VA-AKI) occurrence.Results All patients were at least 60 years old(median age = 81 years). The proportion of patients with target trough concentration achievement(≥ 15 mg/L) with the initial vancomycin regimen was significantly higher in the study group compared to the control group(75.8% vs. 42.4%, P = 0.006).Forty-five patients(68.2%) achieved clinical success, the median duration of vancomycin therapy was10.0 days, and VA-AKI occurred in eight patients(12.1%). However, there were no significant differences in these parameters between the two groups. The model for predicting vancomycin trough concentrations was upgraded to: serum trough concentration(mg/L) = 17.194-0.104 × creatinine clearance rate(mL/min) + 0.313 × vancomycin daily dose [mg/(kg·d)].Conclusion A vancomycin dosage strategy based on a serum trough concentration model can improve the proportion of patients achieving target trough concentrations in elderly patients with severe pneumonia.
文摘Vancomycin hydrochloride(VANH),the first glycopeptide antibiotic,is a water-soluble drug for the treatment of acute osteomyelitis.Liposomal formulations of VANH have already been manipulated and characterized,which was a mean of increasing their therapeutic index,reducing their toxicity and altering drug biodistribution.One of the challenges for preparing VANH-Lips is their low encapsulation efficiency(EE).In the present study,we aim to improve the liposomal formulation of VANH for higher EE,longer systemic circulation,reduced nephrotoxicity and enhanced antimicrobial activities.Vancomycin hydrochloride-loaded liposomes(VANH-Lips)were formulated by the method of modified reverse phase evaporation.Based on the optimization of formulation with orthogonal experimental design,the average drug encapsulation efficiency and the mean particle size of VANH-Lips were found to be 40.78±2.56%and 188.4±2.77 nm.In vitro drug release of VANH-Lips possessed a sustained release characteristic and their release behavior was in accordance with the Weibull equation.After intravenous injection to mice,the mean residence time(MRT)of VANH-Lips group was significantly prolonged in vivo and the AUC value was improved as well compared with the vancomycin hydrochloride solution(VANH-Sol)group.Furthermore,the biodistribution results in mice showed that VANH-Lips decreased the accumulation of VANH in kidney after intravenous injection.In conclusion,VANH-Lips may be a potential delivery system for VANH to decrease nephrotoxicity in the treatment of osteomyelitis.
基金supported by the Robert A.Welch Foundation(Y0026)the French National Center for Scientific Research(ISA-CNRS-UMR5280)
文摘Current trends in chiral analysis of pharmaceutical drugs are focused on faster separations and higher separation efficiencies, Core-shell or superficially porous particles （SPP） based chiral stationary phases （CSPs） provide reduced analysis times while maintaining high column efficiencies and sensitivity. In this study, mobile phase conditions suitable for chiral analyses with electrospray ionization LC-MS were systematically investigated using vancomycin as a representative CSP. The performance of a 2.7 μm SPP based vancomycin CSP （SPP-V） 10 cm ×0.21 cm column was compared to that of a corresponding 5 μm fully porous particles based analogue column. The results demonstrated that the SPP-V column provides higher efficiencies, 2-5 time greater sensitivity and shorter analysis time for a set of 22 basic pharma- ceutical drugs. The SPP-V was successfully applied for the analysis of the degradation products of racemic citalopram whose enantiomers could be selectively identified by MS.
基金Supported by the Public Health Program of Regione Piemonte(Italy),No.2472/DA2001(to Paolo Cotogni,in part)
文摘AIMTo investigate the incidence and risk factors for van-comycin concentrations less than 10 mg/L during cardiac surgery.METHODSIn this prospective study, patients undergoing cardiac surgery received a single dose of 1000 mg of van-comycin. Multiple arterial samples were drawn during surgery. Exclusion criteria were hepatic dysfunction; renal dysfunction; ongoing infectious diseases; solid or hematologic tumors; severe insulin-dependent diabetes; body mass index of 〈 17 or 〉 40 kg/m2; pregnancy or lactation; antibiotic, corticosteroid, orother immunosuppressive therapy; vancomycin or non-steroidal anti-inflammatory drug therapy in the previous2 wk; chemotherapy or radiation therapy in the previous 6 mo; allergy to vancomycin or cefazolin; drug abuse; cardiac surgery in the previous 6 mo; previous or scheduled organ transplantation; preoperative stay in the intensive care unit for more than 24 h; emergency procedure or lack of adequate preparation for surgery; and participation in another trial.RESULTSOver a 1-year period, 236 patients were enrolled, and a total of 1682 serum vancomycin concentrations （median 7/patient） were measured. No vancomycin levels under 10 mg/L were recorded in 122 out of 236 patients （52%）, and 114 out of 236 patients （48%） were found to have at least 1 serum sample with a vancomycin level 〈 10 mg/L; 54 out of 236 patients （22.9%） had at least 5 serum samples with a vancomycin level lower than 10 mg/L. Vancomycin infusion was administered for 60 min in 97 out of 236 patients （41%）. In 47 patients （20%）, the duration of infusion was longer than 60 min, and in 92 patients （39%） the duration of infusion was shorter than 60 min. The maximum concentration and area under the concentration-time curve were significantly higher in patients with no vancomycin levels less than 10 mg/L （ P 〈 0.001）. The multivariate analysis identifiedfemale gender, body mass index （BMI） 〉 25 kg/m , and creatinine clearance above 70 mL/min as risk factors for vancomycin levels less than 10 mg/L.CONCLUSIONResults of this study identified female gender, BMI 〉 25 kg/m2, and creatinine clearance above 70 mL/min as risk factors for suboptimal vancomycin serum concentration during cardiac surgery; no relationship was found bet-ween infusion duration and vancomycin levels less than 10 mg/L. These findings call attention to the risk of facilitating the emergence of vancomycin-resistant methicillin-resistant Staphylococcus aureus strains.
基金the Beijing Tongren Hospital,Capital Medical University Institutional Review Board(Approval No.TRECKY2020-100).
文摘BACKGROUND Vancomycin and teicoplanin are both antibiotics that have significant antimicrobial effects on Gram-positive cocci.AIM To explore the value of teicoplanin combined with conventional(vancomycin only)anti-infective therapy for the treatment of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis pulmonary infections.METHODS A total of 86 patients with methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis pulmonary infections,treated in our hospital between January 2018 and February 2020,were assigned to the study and control groups using a random number table method,with 43 patients in each group.The control group received conventional treatment(vancomycin),and the study group received both teicoplanin and conventional treatment.The following indicators were assessed in both groups:the time required for symptom relief,treatment effectiveness,serum levels of inflammatory factors(procalcitonin,interleukin-1β,tumor necrosis factor-α,C-reactive protein),clinical pulmonary infection scores before and after treatment,and the incidence of adverse reactions.RESULTS Patients in the study group were observed to have faster cough and expectoration resolution,white blood cell count normalization,body temperature normalization,and rales disappearance than patients in the control group(all P<0.05);the total rate of effectiveness was 93.02%in the study group,higher than the 76.74%in the control group(P<0.05).The pre-treatment serum levels of procalcitonin,interleukin-1β,tumor necrosis factor-α,and C-reactive protein as well as the clinical pulmonary infection scores were similar among the patients in both groups.However,the post-treatment serum levels of procalcitonin,interleukin-1β,tumor necrosis factor-α,and C-reactive protein as well as the clinical pulmonary infection scores were significantly lower in the study group than in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the groups.CONCLUSION Compared with conventional(vancomycin only)therapy,teicoplanin and vancomycin combination therapy for patients with pulmonary methicillinresistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis infections can improve patient clinical symptoms,modulate serum inflammatory factor levels,and improve treatment efficacy,without increasing the risk of adverse reactions.
基金The Inner Mongolia Autonomous Region People's Hospital Training Talent Research Start-up Fund,No.BS201703.
文摘BACKGROUND Thrombocytopenia is a serious complication in the medical practice of numerous drugs.Vancomycin is frequently used for the prophylaxis and treatment of suspected or identified methicillin-resistant positive infections.Several cases with vancomycin-induced thrombocytopenia(VIT)have been reported.However,these have rarely been extensively reviewed.The present report describes a case of VIT in endocarditis,and reviews all VIT cases reported in the literature.CASE SUMMARY A 26-year-old male diagnosed with infective endocarditis was admitted.The patient was treated with multiple drugs,including vancomycin,which was initially intravenously given at 1000 mg every 12 h and subsequently at 500 mg every 8 h on day 3.On day 11,the platelet count decreased to 51×10^(9)/L,vancomycin was switched to 500 mg every 12 h,and platelet transfusion was given.On day 17,the platelet count dropped to 27×10^(9)/L,and platelet transfusion was administered again.On day 23,vancomycin was adjusted to 500 mg every 8 h as the trough concentration dropped to the minimum effective concentration.On day 33,the platelet count declined to approximately 40×10^(9)/L.After platelet transfusion,the platelet count rebounded to 90×10^(9)/L on day 35 but dropped again to 42×10^(9)/L on day 43.Based on the time-to-platelet count curve and Naranjo’s Adverse Drug Reaction Probability Scale score,VIT was suspected.After vancomycin discontinuation and platelet transfusion,the platelet count gradually normalized.CONCLUSION The diagnosis of VIT can be achieved through the time-to-platelet count curve and Naranjo’s Adverse Drug Reaction Probability Scale score.The platelet count cannot be normalized simply by platelet transfusion alone,and vancomycin discontinuation is essential.
基金the National Natural Science Foundation of China(Nos.51233004,51021003,51273196 and 51203153)
文摘A series of biodegradable hydrogels based on dextran and poly（L-glutamic acid） were fabricated for effective vancomycin loading and release. The preparation of hydrogels was simply achieved by photo cross-linking of methacrylated dextran and poly（L-glutamic acid）-g-hydroxyethyl methacrylate （PGH） in the presence of photoinitiator 12959. The structures of hydrogels were characterized by FTIR and SEM. The swelling and enzymatic degradation behaviors of hydrogels were examined to be dependent on the poly（L-glutamic acid） content in the hydrogels. The higher content of poly（L-glutamic acid） in the gel, the higher swelling ratio and quicker degradation were observed. More interestingly, the hydrogel with higher PGH ratio showed higher vancomycin （VCM） loading content, which might be due to the electrostatic interaction between carboxylate groups in hydrogel and ammonium group of VCM. In vitro drug release from the VCM-loaded hydrogels in aqueous solution exhibited sustained release of VCM up to 72 h, while the in vitro antibacterial test based on the VCM-loaded hydrogel showed an efficient Methicillin-Resistant S. aureus （MRSA） inhibition extending out to 7 days. These results demonstrated that the biodegradable hydrogels which formed by in situ photo-cross linking would be promising as scaffolds or coatings for local antibacterial drug release in tissue engineering.
文摘This study aimed to develop a guideline for therapeutic drug monitoring（TDM） of vancomycin. We adopted the new guideline definition from the Institute of Medicine（IOM）, adhered closely to the six domains of the Appraisal of Guidelines for Research ＆ Evaluation Ⅱ（AGREE Ⅱ）, and made recommendations based on systematic reviews. We established a Guideline Steering Group and a Guideline Development Group, formulated 12 questions in the form of Population, Intervention, Comparison, Outcome（PICO） and completed a literature search. As far as we know, we will develop the first evidenced-based guideline for vancomycin TDM under the framework of the Grade of Recommendations Assessment, Development and Evaluation（GRADE）.
基金the National Natural Science Foundation of China(No.81873059&81673662)the National Key Research and Development Program of China(No.2017YFC1700200)Shuguang Scholar(16SG36)at Shanghai Institutions of Higher Learning from Shanghai Municipal Education Commission。
文摘Liver injury caused by acetaminophen(AP)overdose is a leading public health problem.Although APinduced liver injury is well recognized as the formation of N-acetyl-p-benzoquinone(NAPQI),a toxic metabolite of AP,resulting in cell damage,emerging evidence indicates that AP-induced liver injury is also associated with gut microbiota.However,the gut microbiota-involved mechanism remains largely unknown.In our study,we found that vancomycin(Vac)pretreatment(100 mg/kg,twice a day for 4 days)attenuated AP-induced liver injury,altered the composition of gut microbiota,and changed serum metabolic profile.Moreover,we identified Vac pretreatment elevated cecum and serum 2-hydroxybutyric acid(2-HB),which ameliorated AP-induced cell damage and liver injury in mice by reducing AP bioavailability and elevating GSH levels.Our current results revealed the novel role of 2-HB in protecting AP-induced liver injury and add new evidence for gut microbiota in affecting AP toxicity.
基金Guidance Project of Fujian Science and Technology Department(Grant No.2017Y0033)Fujian Medical Innovation Project(Grant No.2017-CX-31)+1 种基金Sail Project of Fujian Medical University(Grant No.2017XQ1068)“Weak Discipline Construction Project” of Shanghai Municipal Commission of Health and Family Planning(Grant No.2016ZB0301-01).
文摘In the present study, we aimed to develop a population pharmacokinetics(PPK) model of vancomycin(VCM) and propose the individualised dosage regimen for Chinese elderly patients. The data were collected prospectively from Chinese elderly patients receiving VCM therapy. Steady-state trough concentrations of VCM were determined using an enzyme-multiplied immunoassay. Patients’ sex, age, body weight, concomitant medications, infection type, and laboratory findings were recorded. The PPK model was developed using nonlinear mixed-effects model software. Moreover, we used Monte Carlo simulations to develop an initial dosage regimen targeting various VCM through concentration ranges based on the final model. We found that VCM clearance(CL) was significantly influenced by post-craniotomy meningitis(PCM) and glomerular filtration rate in elderly patients. Additionally, a new dosage regimen was proposed to individualise VCM regimen for PCM and non-PCM elderly patients. A PPK model was established to estimate the individual VCM CL for elderly patients, which could be applied for individualising doses in the target population.
文摘BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.
文摘Vancomycin-resistant Enterococcus faecalis pose an emerging health risk, but little is known about the precise epidemiology for vancomycin resistance. The glycopeptide resistant was studied using different techniques such as broth macrodilution, agar dilution combined with agar diffusion, morphology cell changes by scanning electron microscopy. Eight VREF isolated from different clinical samples were used. Results showed low level and high level resistant to vancomycin antibiotic at concentration of 64 to 128 μg/ml, but antibacterial activity was reduced to 256 μg/ml, the SEM revaled increased in the cell size with the antibiotic compared to control and standard culture. The technique constitutes simple method for the detection of organism.
