24. INVESTIGATION ON THE USE AND THERAPEUTIC VANCOMYCIN MONITORING AT NGUYEN TRAI HOSPITAL
Main Article Content
Abstract
Objectives: To survey the characteristics of infection, characteristics of Vancomycin use, monitoring of Vancomycin blood concentration and treatment results at Nguyen Trai Hospital, Ho Chi Minh city.
Methods: A descriptive cross-sectional study was conducted on 82 records with indication of Vancomycin concentration monitoring at Nguyen Trai Hospital from June 1, 2023 to February 29, 2024.
Results: 86.6% of the patients had renal impairment and 21.9% of the patients were on hemodialysis. Approximately 29.6% of all patients were identified as positive for Gram-positive bacteria, with 87.5% of these having MIC of Vancomycin ≤ 1 mg/L. In the non-dialysis group, the rates of achieving target AUC/MICs were 23.3% and 66.7% respectively for intermittent infusion and continuos infusion. In the dialysis group, 8.3% of patients on intermittent dialysis and 33.3% of those on continuous dialysis achieved the target ranges. Acute kidney injury was observed in 9.7% of patients, classified as R and I according to the RIFLE criteria with equal percentages of 4.9%.
Conclusion: The proportion of patients achieving therapeutic targets was comparatively low. Nguyen Trai Hospital needs to implement specific protocols for special patient subpopulations, guidelines on calculating proper dosing regimens for renal impairement patients.
Article Details
Keywords
Vancomycin, therapeutic drug monitoring, , elderly patients.
References
[2] Rybak M.J, Le J, Lodise T.P et al. Therapeutic monitoring of Vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. American Journal of Health-System Pharmacy, 2020, 77 (11), 835-864.
[3] Trần Vân Anh. Phân tích tình hình sử dụng và giám sát nồng độ Vancomycin trong máu trên bệnh nhân người lớn tại Bệnh viện Đa khoa Quốc tế Hải Phòng. Tạp chí Y học Việt Nam, 2022, 511 (2), 270-274
[4] Trần Ngọc Phương Minh. Đánh giá hiệu quả của việc áp dụng hướng dẫn theo dõi nồng độ Vancomycin trong trị liệu tại Bệnh viện Đại học Y Dược thành phố Hồ Chí Minh. Tạp chí Nghiên cứu Dược và Thông tin thuốc, 2019, 10 (3), 30-37.
[5] Walraven C.J, North M.S, Marr-Lyon L, Deming P, Sakoulas G, Mercier R.C. Site of infection rather than Vancomycin MIC predicts Vancomycin treatment failure in methicillin-resistant Staphylococcus aureus bacteraemia. The Journal of antimicrobial chemotherapy, 2011, 66 (10): 2386-92.
[6] Lưu Thị Thu Trang. Phân tích đặc điểm sử dụng Vancomycin trong điều trị nhiễm khuẩn huyết tại Trung tâm Bệnh nhiệt đới, Bệnh viện Bạch Mai. Khóa luận tốt nghiệp dược sỹ, Trường Đại học Dược Hà Nội, 2020.
[7] Van Hal S.J, Paterson D.L, Lodise T.P. Systematic review and meta-analysis of Vancomycin - induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrobial agents and chemotherapy, 2013, 57 (2): 734-44.
[8] Hao J.J, Chen H, Zhou J.X. Continuous versus intermittent infusion of Vancomycin in adult patients: A systematic review and meta-analysis. International, 2016.
[9] Bộ Y tế, Bệnh viện Bạch Mai. Hướng dẫn sử dụng kháng sinh trong lâm sàng tại Bệnh viện Bạch Mai, 2023.