Study On Optimization Of Vancomycin Administration Regimen Based On Population Pharmacokinetics Under The Guidance Of Clinical Pharmacists

Objective: To evaluate the intervention effect of optimizing vancomycin administration regimen based on population pharmacokinetics under the guidance of clinical pharmacists,and analyze the factors affecting the prediction accuracy of JPKD-vancomycin software,so as to provide a basis for individualized guidance of drug use.Methods: The inpatients treated with vancomycin and TDM in the Affiliated Suzhou Hospital of Nanjing Medical University from July 2013 to December 2017 were retrospectively collected as the control group,and the inpatients from January 2018 to December 2018 were prospectively collected as the intervention group.Vancomycin administration regimen,trough concentration,TDM status,clinical efficacy and adverse drug reaction were compared between the two groups,and univariate and multivariate Logistic regression analysis was used to screen the influence factors of JPKD-vancomycin software prediction accuracy.Results: A total of 467 TDM data were collected from 310 patients included in this study,including 190 cases in the control group and 120 cases in the intervention group.Compared with the control group,the TDM monitoring rate and timing rationality rate of TDM in the intervention group were significantly increased(75.09% vs.38.34%,61.31% vs.42.91%,both P<0.001).The compliance rate of trough concentration after adjustment was significantly increased(62.03% vs.42.31%,P=0.013).There was no significant difference in clinical effective rate,Gram-positive bacterial clearance rate,incidence of acute kidney injury(AKI),28-day mortality and hospitalization time between the two groups(P>0.05).Compared with the initial regimen,the weighted residuals(WRES)of the JPKD-vancomycin software for adjusting the regimen was significantly reduced(14.84 vs.20.41,P<0.001),and the proportion of WRES<30% was significantly increased(82.80% vs.63.87%,P<0.001).Univariate Logistics regression analysis showed that female,small body mass,short height,low clearance rate and postoperative patients were related to the inaccurate prediction of JPKD-vancomycin software.Multivariate Logistic regression analysis showed that female,low clearance rate and postoperative patients were independent risk factors for inaccurate prediction of JPKD-vancomycin software.Conclusion: Using JPKD-vancomycin software to optimize vancomycin administration regimen under the guidance of clinical pharmacists can effectively improve the TDM monitoring rate and timing rationality rate of TDM,and can significantly increase the compliance rate of vancomycin trough concentration when used to adjust the administration regimen,while not increasing the incidence of AKI and 28-day mortality.The accuracy of using JPKD-vancomycin software to predict vancomycin trough concentration in female,low clearance rate and postoperative patients was lower than that in other populations.