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

Abstract

This study aimed to describe the use of vancomycin on adult patients and the routine therapeutic drug monitoring (TDM) activity in Haiphong International Hospital according to the institutional approved guideline. Information of vancomycin use and TDM of 142 admitted patients from 2019 to 2020 were retrospectively reviewed. The patients median age was 51 years [IQR: 34 – 67]. Renal function fluctuated substantially with median Clcr was 83.8 mL/min [IQR: 62.8-110.8]. The most common isolated pathogen was MRSA (n = 88; 77.2%). Loading dose was observed in 40.2% of patients receiving intermittent infusions with a median of 28.8 mg/kg and in 80% of patients receiving continuous infusions with a median of 27.3 mg/kg. Among patients receiving intermittent infusions, a total maintenance dose at 2g or 3g over 24h was used on patients with different renal function. The vancomycin trough concentrations showed a high inter-individual variation. Dose adjustment increased vancomycin levels but not significantly from 10.9 mg/L to 14.1 mg/L, p = 0.554 with intermittent infusion and from 21.7 mg/L to 23.9 mg/L, p=0.312 with continuous infusion. The target concentration attainment was improved after 1^st and 2^nd dose adjustment from 40.9% to 49.6%  in intermittent infusion and from 40.0 % to 53.3% in continuous infusion. These findings emphasize the necessity of TDM vancomycin in individualizing the vancomycin use to maximize the efficacy while avoiding the toxicity.