| Objective:To analyze the clinical status of combined application of vancomycin in the treatment of neonatal infection,combined with the determination of vancomycin blood concentration,which provides a basis for the clinical application of vancomycin and promotes rational use of drug.Methods:The clinical data of using vancomycin in the treatment of neonatal infection from January 2013 to May 2017 in the first affiliated Hospital of Guangxi Medical University were collected by retrospective analysis,and the basic information,disease distribution,pathogenic examination,PCT,CRP and WBC tests,vancomycin dosing regimen,antimicrobial drugs combination,steady-state trough concentration,clinical efficacy,adverse reactions and other indicators were analyzed.Results:?1?A total of 45 cases of newborns were included;The proportion of neonatal patients with neonatal pneumonia was the highest in 45 cases,accounting for 20 cases?44.44%?,followed by neonatal sepsis,15 cases?33.33%?.The detection rate of pathogenic examination was 100%,and the positive detection rate was 53.3%,including 16 cases of Gram-positive bacterium,8 cases of Gram-negative bacterium,and 2 cases of mixed infection.The detection rate of WBC and CRP was 100%,PCT was 75.6%.The average medication duration of vancomycin was?16.96±8.96?d,the initial drug regimen was administered at 10-15 mg·kg-1,every 8 or 12 hours.A total of 43 cases of two or more antimicrobial agents were used in combination,with a ratio of95.6%,of which 27 cases were combined with meropenem,13 cases with piperacillin sodium and tazobactam sodium,9 cases with cefoperazone sodium and sulbactam sodium,and 27 cases with fluconazole.The steady-state plasma concentrations of vancomycin was monitored 91 times with an average value of?11.90±10.08??g·ml-1.And the total effective rate was 84.44%,none of the neonates had hearing loss,acute kidney injury and liver damage.?2?Among 45neonates,the neonates with a dosing regimen of 10-15 mg·kg-1,q12h had the plasma concentrations monitored for 39 times,and the dosing regimen for neonates was 10-15 mg·kg-1,q8h,the blood concentration was monitored for 42times.There was no significant difference in the concentration of vancomycin between the two groups?P<0.05?.?3?The liver and kidney function indexes after the administration of vancomycin in 45 neonates were lower than before,and the differences of BUN,Scr and TBiL were statistically significant?P<0.05?.However,there was no significant difference in CysC,AST and ALT?P>0.05?.?4?91 vancomycin steady-state trough concentrations were divided into a low concentration group(<20?g·ml-1),a medium concentration group(1020?g·ml-1)and a high concentration group(>20?g·ml-1).The renal function indexes of the low concentration group(<20?g·ml-1)and the medium concentration group(1020?g·ml-1)were lower than those before the determination,and the comparison of BUN and Scr was statistically significant in the low concentration group?P<0.05?.Compared with the renal function indexes before and after concentration determination,the renal function indexes of the high concentration group(>20?g·ml-1)was higher than those before the drug administration,but the difference was not statistically significant?P>0.05?.The liver function indexes after concentration determination were lower than before in all valley concentration groups,and the comparison of TBiL was statistically significant in the low concentration group?P<0.05?.Conclusion:With the combined application of vancomycin,the treatment efficiency of the neonatal infection is 84.44%in this study,and less related adverse reactions of hearing,liver and renal function occurred.However,attention should be paid to the renal function damage caused by high concentration.In order to promote the rational use of vancomycin,it is still necessary to strengthen the monitoring of blood drug concentration and renal function,and adjust the dosage and frequency according to the clinical situation,so that the treatment is safer and more effective. |
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