THỰC TRẠNG THEO DÕI NỒNG ĐỘ VANCOMYCIN TRÊN BỆNH NHÂN LỌC MÁU LIÊN TỤC TẠI CÁC ĐƠN VỊ HỒI SỨC BỆNH VIỆN TRUNG ƯƠNG QUÂN ĐỘI 108

Abstract

Objective: To analyze the status of vancomycin therapeutic drug monitoring (TDM) in patients undergoing continuous renal replacement therapy (CRRT) in the intensive care units (ICUs) of 108 Military Central Hospital. Subjects and Methods: A prospective observational study was conducted from June 1, 2024, to February 28, 2025, including adult patients treated in intensive care units who received continuous intravenous vancomycin in combination with CRRT and had at least one measured drug concentration sample. Results: A total of 25 patients were included. All patients received continuous venovenous hemodiafiltration (CVVHDF), with a median effluent flow rate of 40.57 mL/hour/kg. Vancomycin was primarily prescribed for respiratory infections (84%) and septic shock (52%). All patients were administered a loading dose, and the average initial maintenance dose was 23.83 ± 10.91 mg/kg/day. Among 113 collected vancomycin samples, only 23.01% reached the target concentration, while 54.87% exceeded 25 mg/L. The proportion of patients who achieved therapeutic target concentrations varied significantly across TDM sessions, peaking at the third session (43.75%). Three cases of excessively high vancomycin concentrations (>60 mg/L) were observed, primarily due to the failure to adjust the maintenance dose after discontinuation of CRRT. Conclusion: These findings highlighted considerable variability in vancomycin concentrations and a low rate of target attainment, underscoring the need for a dedicated dosing and TDM protocol for CRRT patients to enhance therapeutic efficacy and safety.