NỒNG ĐỘ VANCOMYCIN TRONG MÁU Ở TRẺ EM VIÊM MÀNG NÃO TẠI BỆNH VIỆN NHI ĐỒNG 1 NĂM 2023-2024

Abstract

Objectives: Meningitis in children is a severe infectious disease with high risk of neurological sequelae or mortality. Vanvomycin is a commonly prescribed in the treatment and monitoring its blood levels to achieve the target AUC (Area Under the Curve) of 400 – 600mg.h/l range is necessary to ensure therapeutic efficacy and minimize side effects. Materials and methods: A descriptive cross-sectional, prospective study was conducted from March 2023 to June 2024 at the Infectious - Neurology department of Children's Hospital 1, involving pediatric patients aged 1 month to 16 years, were diagnosed with bacterial meningitis, received vancomycin treatment for at least 48 hours, were indicated for vancomycin serum concentration monitoring. Results: Among 94 patients in this study, 71,3% male, 29,8% had nutritional issues, 58,5% had comorbidities. The median duration of vancomycin use was 14 days. At the first monitor of vancomycin (T₁), the median AUC was 441 mg.h/l, 48,9% of patients achieved the target AUC. At the second monitor of vancomycin (T₂), the median AUC was 532 mg.h/l, 67,9% of patients achieved the target AUC. The median hospital stay was 18 days. Complications occurred in 23,4% of patients, no sequelae or mortality were recorded. There were statistically significant differences in BMI (p = 0,026), comorbidities (p = 0,004), hospital length (p = 0,033) between the groups that did and did not achieve the target AUC. Some factors associated with not achieving the target AUC included BMI (OR = 0,75), comorbidities (OR = 0,16). Conclusions: Pediatric patients with high BMI and/or comorbidities are at risk of not achieving the target AUC after 48 hours of vancomycin treatment, thus necessitating close monitoring of vancomycin and clinical response in children with meningitis