万古霉素治疗耐甲氧西林金黄色葡萄球菌感染的 血药谷浓度监测及疗效探讨.

OBJECTIVE: To explore the blood trough concentration monitoring and efficacy of vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection, and to probe into the relationship between blood trough concentration and clinical efficacy. METHODS: Totally 362 patients with MRSA infection admitted into this hospital from Jan. 2020 to Aug. 2021 were selected and treated with vancomycin, the distribution of the first measurement of blood trough concentration was collected, the influencing factors of blood trough concentration of vancomycin was analyzed, the efficacy and incidence of adverse drug reactions in patients with different blood trough concentrations were compared, the medication regimen was adjusted according to the blood trough concentration of vancomycin. RESULTS: Of the 362 patients with MRSA infection treated with vancomycin, 40. 33%(146 cases)of the first detection of blood trough concentration were in the target concentration range; results of the orderly multiclassification logistic regression model analysis showed that age, body mass index, renal insufficiency, menstruum of 0. 9% sodium chloride injection, combined application of meropenem, and the rationality of therapeutic regimen were the influencing factors of blood trough concentration of vancomycin in patients with MRSA infection (P<0. 05); with the increase of blood trough concentration, the treatment efficiency tended to increase, and the treatment efficiency of those with blood trough concentration >20 mg / L was higher than that of those with blood trough concentration <10 mg / L, with statistically significant difference (P<0. 05); with the increase of blood trough concentration, the incidence of adverse drug reactions tended to increase, and the incidence of those with blood trough concentration >20 mg / L was higher than that of those with blood trough concentration <10 mg / L and 10-20 mg / L, with statistically significant difference (P<0. 05), and the difference in the incidence of renal impairment was particularly significant. 31 patients with blood trough concentration of vancomycin <10 mg / L and ineffective treatment who had adjusted the medication regimen were retested, of which 26 patients had reached the target trough concentration; 21 patients with trough concentrations >20 mg / L and effective treatment who had adverse drug reactions were relieved after withdrawl, 16 patients with trough concentrations >20 mg / L and ineffective treatment who were given other drugs. CONCLUSIONS: The treatment of MRSA infection with ancomycin varies significantly on individual basis, especially for special groups such as children, elderly, obese, and renal insufficiency, blood concentration monitoring needs to be strengthened, and the medication regimen should be adjusted according to the blood concentration monitoring results, so as to improve the therapeutic effect while ensuring therapeutic safety. [ABSTRACT FROM AUTHOR]