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Evaluation Of The Relationship Between Vancomycin Trough Concentrations And The Vancomycin-associated Acute Kidney Injury/Efficacy

Posted on:2015-02-05Degree:MasterType:Thesis
Country:ChinaCandidate:X R NiuFull Text:PDF
GTID:2284330461960512Subject:Clinical Medicine
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Evaluation of the Relationship Between Different Level Vancomycin Trough Concentrations and Vancomycin-associated Acute Kidney Injury/EfficacyPart 1Evaluation of the Relationship Between Vancomycin Trough Concentrations and the Incidence of Vancomycin-associated Acute Kidney Injuryobjective The purpose of this study was to discuss the relationship between vancomycin trough concentrations and the incidence of vancomycin-associated acute kidney injury. Analyze the clinical characteristics of vancomycin-related acute kidney injury (AKI) in patients.Methods This was a prospective study of 74 patiens with severe infections who were receiving vancomycin from February 1st 2013 to January 1st 2014 in Affiliated Drum Tower Hospital of Nanjing University Medical School. Vancomycin trough concentrations, serum creatinine and creatinine clearance were monitored during therapy.Date collected included the vancomycin dose, length of vancomycin therapy. According to the change in serum creatinine during vancomycin therapy, patients were divided AKI group and non-AKI group, comparing vancomycin initial trough concentrations, mean trough concentrations and maximum trough concentration.These were used to identify in multivariate regression analysis, receiver operating characteristic (ROC) curves constructed to the parameters that have significant difference. Results Among 74 subjects,19(26.7%)develeped acute kidney injury, The rate of recovery of renal function was 57.9%.The initial vancomycin through concentrations, average vancomycin trough concentrations, maximum trough concentration were higher among patients in AKI group than the patients in non-AKI group(p< 0.05).Multivariate modeling identified that the average vancomycin trough concentrations[odd ratio(OR) 1.133,95% confidence interval(95% CI 1.029-1.247), p=0.011] were the independent predictors for vancomycin associated acute kidney injury. Receiver operating characteristic (ROC) curves constructed to study the ability of mean vancomycin concentrations to predict the development of AKI during vancomycin therapy.The area under the ROC curve is 0.815(95%CI,0.709-0.920), p=0.000, average vancomycin trough concentrations ≥17.3g/mL enabled the prediction of AKI during vancomycin therapy with a sensitivity of 52.6% a specificity of 82.6%.Conclusion Acute kidney injury may occur in patients with severe infections during treatment of vancomycin.The average vancomycin trough concentrations was the independent predictors for induced acute kidney injury in patients with severe infection. The average vancomycin trough concentrations≥17.3g/mL will increase the risk of AKI.Monitoring of drug concentration is necessary during the vancomycin therapy.Part 2The Relationship between Different Level of Vancomycin Trough Concentrations and EfficacyObjective Discuss the relationship between different level of Vancomycin Trough Concentrations and clinical/bacteriological efficacy for patients with severe infection.Methods 74 patiens with severe infections who were receiving empiric or objective anti-infective therapy with vancomycin were involved in this study from February 1st 2013 to January 1st 2014 in Affiliated Drum Tower Hospital of Nanjing University Medical School. Vancomycin trough concentrations, Date collected included patients’ general conditions, symptoms of infection,infection-related parameters(such as body temperature, white blood cells/neutropil count,CRP and PCT), bacteriological culture and chest X-ray during the vancomycin treatment. Vancomycin trough concentrations were monitored during therapy. According to the clinical efficiency and bacteriological clearance during vancomycin therapy, patients were divided effective group and non-effective group, bacteriological clearance group and non-clearance group.Compare the mean vancomycin trough concentrations.Patients were stratified by mean vancomycin trough concentration level [group A(<10mg/L), group B(10-15mg/L), group C(15-20mg/L), group D(≥20mg/L)].Compare the difference of clinical success, bacteriological clearance, and in-hospital mortality.Result The average vancomycin trough concentrations were higher among patients in effective group than the non-effective group, as well as the bacteriological clearance group(p< 0.05).The clinical efficiency and bacteriological clearance rate were higher in group B, C and D(p<0.05).The in-hospital mortality did not differ among the four groups..Conclusion The clinical and bacterial efficacy of vancomycin were related to the average trough concentration.Higher vancomycin trough concentration level(≥10mg/L) was superior to the lower trough concentration during the treatment.
Keywords/Search Tags:Vancomycin, Trough concentration level, Effcacy, severe infection, bacteriological clearance, Trough concentrations, Acute Kidney Injury, Infection, Creatinine
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