The Nephrotoxicity And Curative Effect Of Vancomysin Serum Concentrations Monitoring In Adult Patients

Background: Vancomysin is widely used antibiotic which treat infection caused by Gram-positive bacteria like MRSA.A vast of factors in clinic practice can alter the efficacy of Vancomysin.It is accepted that detecting concentration of Vancomysin in blood and creatinine clearance rate is necessary for adjusting the dose and time of Vancomysin,which is responsible for good efficacy and reduced side effects.Objective: For intravenous use of vancomycin and monitoring of serum trough concentrations of patients,analysis of the relationship between different serum trough concentration and nephrotoxicity.Discussion on reasonable range and safety of serum trough concentration.Comparing nephrotoxicity group and no nephrotoxicity group serum trough concentration difference,To explore the serum trough concentration for decreasing the occurrence of nephrotoxicity.Explore the other risk factors increase the risk of nephrotoxicity.Analysis of vancomycin serum trough concentration monitoring for clinical curative effect of guiding significance;Methods: This was a single-center retrospective study.The adult patients who were treated with Vancomycin and monitored trough concentrations,form July 1,2013 and August 31,2015.Patient data collected included age,sex,weight,site infections,complicated other diseases,vancomycin serum trough concentration,peak concentration,nephrotoxic drugs,serum creatinine(SCr),creatinine clearance(Cr Cl)and microbiology.we can analysis the relationship between the vancomycin trough concentrations and nephrotoxicity or clinical efficiency in adult Chinese Patients.Results: There were 125 cases of 105 patients who were monitored vancomycin in the hospital.There were 29 cases(23.2%)with vancomycin trough concentration below 10 mg/L,29 cases(44.0%)with vancomycin trough concentration of 10-20mg/L,41 cases(32.8%)with vancomycin trough concentration of above 20mg/L.In the infection,mainly composed of lung infection(60.95%),Check out the gram-positive bacteria strains of 59 cases(54.13%).Give priority to with MRSA infection,the drug sensitivity test showed that vancomycin were all sensitive.Found no resistance.Nephrotoxicity group of median concentration up to 26.06mg/L,no nephrotoxicity group up to 13.2mg/L.The difference was statistically significant(P<0.001).Diabetes(P=0.012)and vasopressors(P=0.023)statistically significant between the two groups.40 cases of Gram-positive bacteria infection in patients,There were 13 cases(32.5%)of bacterial clearance.Comprehensive evaluation of clinical efficiency after treatment with vancomycin clinical effective accounted for 57.5%,Clinical invalid accounted for 42.5%,there was no statistical significance(P=0.254).Conclusions: High vancomycin serum trough concentration,,increase the risk of nephrotoxicity,The serum trough concentration of more than 20 mg/L,significantly increased the incidence of nephrotoxicity,.If the patients with diabetes or the use of vasopressors,will increase the risk of nephrotoxicity.Vancomycin serum trough concentration monitoring and guiding clinical curative,should be combined with the specific patient and comprehensive evaluation,in order to achieve safe and effective treatment.Serum trough concentration conforms to the guidelines recommend accounted for 44.0%,still need to strengthen the concentration monitoring.In gram positive bacteria infection of MRSA was 35.59%,the drug sensitive test showed that all sensitive,no drug resistance.