Vancomycin efficiency and safety of a dosage of 40-60 mg/kg/d and corresponding trough concentrations in children with Gram-positive bacterial sepsis

作者全名："Peng, Lengyue; Guo, Ziyao; Zhang, Guangli; Tian, Xiaoyin; Gu, Ruixue; Li, Qinyuan; Li, Yuanyuan; Luo, Zhengxiu"

作者地址："[Peng, Lengyue; Guo, Ziyao; Zhang, Guangli; Tian, Xiaoyin; Gu, Ruixue; Li, Qinyuan; Li, Yuanyuan; Luo, Zhengxiu] Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Key Lab Child Dev & Disorders, Chongqing Key Lab Pediat,Dept Resp Med,Childrens H, Chongqing, Peoples R China; [Peng, Lengyue] Chongqing Liangjiang New Area, Dept Child Care, Peoples Hosp 1, Chongqing, Peoples R China"

通信作者："Luo, ZX (通讯作者)，Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Key Lab Child Dev & Disorders, Chongqing Key Lab Pediat,Dept Resp Med,Childrens H, Chongqing, Peoples R China."

来源：FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY

ESI学科分类：MICROBIOLOGY

WOS号：WOS:000968172500001

JCR分区：Q1

影响因子：4.6

年份：2023

卷号：13

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：vancomycin; Gram-positive bacterial; children; tough concentrations; dosages

摘要："BackgroundOptimal vancomycin trough concentrations and dosages remain controversial in sepsis children. We aim to investigate vancomycin treatment outcomes with a dosage of 40-60 mg/kg/d and corresponding trough concentrations in children with Gram-positive bacterial sepsis from a clinical perspective. MethodsChildren diagnosed with Gram-positive bacterial sepsis and received intravenous vancomycin therapy between January 2017 and June 2020 were enrolled retrospectively. Patients were categorized as success and failure groups according to treatment outcomes. Laboratory, microbiological, and clinical data were collected. The risk factors for treatment failure were analyzed by logistic regression. ResultsIn total, 186 children were included, of whom 167 (89.8%) were enrolled in the success group and 19 (10.2%) in the failure group. The initial and mean vancomycin daily doses in failure group were significantly higher than those in success group [56.9 (IQR =42.1-60.0) vs. 40.5 (IQR =40.0-57.1), P=0.016; 57.0 (IQR =45.8-60.0) vs. 50.0 (IQR =40.0-57.6) mg/kg/d, P=0.012, respectively] and median vancomycin trough concentrations were similar between two groups [6.9 (4.0-12.1) vs.7.3 (4.5-10.6) mg/L, P=0.568)]. Moreover, there was no significant differences in treatment success rate between vancomycin trough concentrations <= 15 mg/L and >15 mg/L (91.2% vs. 75.0%, P=0.064). No vancomycin-related nephrotoxicity adverse effects occurred among all enrolled patients. Multivariate analysis revealed that a PRISM III score >= 10 (OR =15.011; 95% CI: 3.937-57.230; P<0.001) was the only independent clinical factor associated with increased incidence of treatment failure. ConclusionsVancomycin dosages of 40-60 mg/kg/d are effective and have no vancomycin-related nephrotoxicity adverse effects in children with Gram-positive bacterial sepsis. Vancomycin trough concentrations >15 mg/L are not an essential target for these Gram-positive bacterial sepsis patients. PRISM III scores >= 10 may serve as an independent risk factor for vancomycin treatment failure in these patients."

基金机构："Project of Young and Middle Medical Distinguished Team in Chongqing, China"

基金资助正文："This work is supported by The Project of Young and Middle Medical Distinguished Team in Chongqing, China."