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首页> 外文期刊>Antimicrobial agents and chemotherapy. >A Quasi-Experiment To Study the Impact of Vancomycin Area under the Concentration-Time Curve-Guided Dosing on Vancomycin-Associated Nephrotoxicity
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A Quasi-Experiment To Study the Impact of Vancomycin Area under the Concentration-Time Curve-Guided Dosing on Vancomycin-Associated Nephrotoxicity

机译：一种研究Vancomycin面积在浓度 - 时间曲线引导给药对万古鼠相关肾毒性的影响的准实验

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Evidence suggests that maintenance of vancomycin trough concentrations at between 15 and 20 mg/liter, as currently recommended, is frequently unnecessary to achieve the daily area under the concentration-time curve (AUC24) target of >= 400 mg.h/liter. Many patients with trough concentrations in this range have AUC24 values in excess of the therapeutic threshold and within the exposure range associated with nephrotoxicity. On the basis of this, the Detroit Medical Center switched from trough concentration-guided dosing to AUC-guided dosing to minimize potentially unnecessary vancomycin exposure. The primary objective of this analysis was to assess the impact of this intervention on vancomycin-associated nephrotoxicity in a single-center, retrospective quasi-experiment of hospitalized adult patients receiving intravenous vancomycin from 2014 to 2015. The primary analysis compared the incidence of nephrotoxicity between patients monitored by assessment of the AUC24 and those monitored by assessment of the trough concentration. Multivariable logistic and Cox proportional hazards regression examined the independent association between the monitoring strategy and nephrotoxicity. Secondary analysis compared vancomycin exposures (total daily dose, AUC, and trough concentrations) between monitoring strategies. Overall, 1,280 patients were included in the analysis. After adjusting for severity of illness, comorbidity, duration of vancomycin therapy, and concomitant receipt of nephrotoxins, AUC-guided dosing was independently associated with lower nephrotoxicity by both logistic regression (odds ratio, 0.52; 95% confidence interval [CI], 0.34 to 0.80; P = 0.003) and Cox proportional hazards regression (hazard ratio, 0.53; 95% CI, 0.35 to 0.78; P = 0.002). AUC(g)uided dosing was associated with lower total daily vancomycin doses, AUC values, and trough concentrations. Vancomycin AUC-guided dosing was associated with reduced nephrotoxicity, which appeared to be a result of reduced vancomycin exposure.
机译：证据表明，由于目前推荐的，维持在15至20毫克/升之间的万古霉素槽浓度的维持经常不必在> = 400mg.h /升> = 400mg.h /升的浓度曲线（AUC24）靶标下实现日常区域。许多患有该范围内的槽浓度的患者具有超过治疗阈值的AUC24值，并且在与肾毒性相关的曝光范围内。在此基础上，底特律医疗中心从低谷集中引导给药到AUC引导的剂量，以最小化可能不必要的万古霉素暴露。该分析的主要目标是评估该干预在2014至2015年接受静脉内万霉素的住院成年患者的单一中心，回顾性准实验中对万古霉素相关的肾毒性的影响。主要分析与肾毒性之间的发病率相比通过评估AUC24和通过评估槽浓度监测的患者。多变量逻辑和COX比例危害回归检测监测策略与肾毒性之间的独立关联。二次分析与监测策略之间的万古霉素暴露（总日剂量，AUC和浓度）比较。总体而言，分析中包含1,280名患者。调整疾病的严重程度后，使万古霉素治疗的持续时间，以及伴随肾毒素的接收，AUC引导的给药通过逻辑回归（差距比，0.52; 95％置信区间[CI]，0.34至0.34，0.34至0.80; p = 0.003）和Cox比例危害回归（危险比，0.53; 95％Ci，0.35至0.78; p = 0.002）。 AUC（G）粘液剂量与较低的每日万古霉素剂量，AUC值和槽浓度有关。万古霉素AUC引导的给药与肾腺毒性降低有关，这似乎是减少万古霉素暴露的结果。

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