Clinical Pharmacists’ Individualized Medication Guidance Study Of Vancomycin Based On Blood Concentration

Vancomycin(VAN),as the first tricyclic glycopeptide natural antibiotic,is a first-line drug recommended by many authoritative guidelines for the treatment of Methicillin-resistant Staphylococcus aureus(MRSA),but its treatment window is narrow,and it is found that there are individual differences during clinical treatment,and therapeutic drug monitoring(TDM)is required.This study intends to evaluate the clinical significance of clinical pharmacists during vancomycin treatment by propensity score matching method,and then construct a quantitative evaluation model for the risk of abnormal vancomycin blood concentration,and finally calculate the ratio of the area under the curve to the minimum inhibitory concentration(AUC/MIC)according to the Bayesian feedback method,To compare the relationship between the predicted treatment effect and the actual treatment effect when the blood vancomycin concentration reaches the target(10～20 μg/m L)and the AUC/MIC reaches the target(≥ 400 h)within 24 hours and screen out TDM targets that are more suitable for Chinese patients,so as to improve the individualized medication guidance process,and provide a theoretical basis for the realization of individualized vancomycin medication.Objective:1.Assess the clinical significance of clinical pharmacists during the intervention period of vancomycin medication;2.Establish a quantitative prediction model for the risk of abnormal blood concentration of vancomycin,a nomogram;3.Determine the target of TDM suitable for clinical pharmacists in the Chinese patient population,and improve the guidance process for individualized vancomycin medication.Methods:1.This study collected information on patients who were hospitalized with vancomycin anti-infective therapy in a tertiary teaching hospital from January 2017 to December 2020.According to the inclusion and exclusion criteria,patients who met the criteria were screened out,and then Propensity Score Matching(PSM)balances the confounding factors of the clinical pharmacist intervention group(test group)and the clinical pharmacist non-intervention group(control group),and compares the efficacy,safety and economic indicators between the two groups.2.According to the inclusion and exclusion criteria,collect basic information of hospitalized patients who have undergone vancomycin blood concentration monitoring,establish a quantitative evaluation model for the risk of abnormal vancomycin blood concentration,a nomogram,and conduct internal and external verification.So as to improve the medication process of vancomycin in hospitals,and realize individualized medication guidance.3.According to the inclusion and exclusion criteria,the information of patients who have undergone vancomycin blood concentration monitoring was screened and collected,and the relevant information was input into the JPKD software to calculate the clearance(CL)through the Bayesian feedback method.Then calculate the AUC/MIC value when the MIC is 0.5 μg/m L,1 μg/m L,2 μg/m L and 4 μg/m L.Finally,the relationship between the predicted therapeutic effect and the actual therapeutic effect when the blood concentration of vancomycin reaches the target(10～20 μg/m L)and the AUC/MIC(≥400 h)is compared,and targets that are more suitable for Chinese patients are screened.Results:1.During the period from January 2017 to December 2020,a total of 3850 hospitalized patients were treated with vancomycin for anti-infective treatment.After inclusion and exclusion and PSM,96 cases were retained in each group;there were 8 confounding factors before PSM,which is statistically significant(P <0.05),and there is only one confounding factor after PSM,which is statistically significant(P < 0.05);In the analysis of outcome indicators,creatinine,vancomycin medication days,the proportion of days,the cost of vancomycin,and the cost proportion were statistically significant(P < 0.05).2.In the construction of the nomogram,17 factors were statistically different in the univariate analysis(P < 0.05).After the multivariate logistic regression analysis,a total of 8 factors were included in the construction of the nomogram model,the internally verified AUC value is 0.706,the sensitivity is 57.38%,and the specificity is 78.95%,the externally verified AUC value is 0.527,the sensitivity is 46.46%,and the specificity is 61.33%.3.According to the inclusion and exclusion criteria,a total of 213 patients were included in the study.The Vd and CL values were calculated by Bayesian feedback method.The average value of Vd was 50.16±30.05 L,and the average value of CL was 3.38±2.44 L/hr.When MIC=0.5 μg/m L,AUC/MIC=971.73±593.40 h;when MIC=1 μg/m L,AUC/MIC=485.86±296.70 h;when MIC=2 μg/m L,AUC/MIC=242.93 ±148.35 h;when MIC=4 μg/m L,AUC/MIC=121.47±74.18 h.The prediction effect is: AUC/MIC(MIC=0.5 μg/m L)>AUC/MIC(MIC=1μg/m L)> blood concentration>AUC/MIC(MIC=2 μg/m L)>AUC/MIC(MIC=4μg/m L).Conclusions:Although the clinical benefit of clinical pharmacists is not obvious,they can improve the individualized medication process of vancomycin based on the constructed nomogram model and the determined TDM target(AUC/MIC),thereby improving the efficacy,safety and economy during medication.