Effect of dynamic monitoring based on renal function indexes on the efficacy and safety of vancomycin in the treatment of MRSA pneumonia in elderly patients

Feng Hui

Article ID: 2102
Vol 4, Issue 1, 2023
DOI: https://doi.org/10.54517/urr.v4i1.2102
VIEWS - 2444 (Abstract)

Download PDF

Abstract

Objective: To explore the feasibility of dynamic monitoring based on renal function indexes to evaluate the efficacy and safety indexes of vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in elderly patients, and to provide reference for the evaluation of the feasibility of vancomycin pharmaceutical care. Methods: 118 elderly patients with MRSA pneumonia treated from March 2017 to February 2020 were divided into routine treatment group (n=56) and intervention group (n=62). Patients in the routine treatment group were treated with routine vancomycin, while patients in the intervention group flexibly adjusted the dosage of vancomycin according to the dynamic monitoring of endogenous creatinine clearance (CCR), blood creatinine (SCR) and urea nitrogen (BUN). The changes of CCR, SCR and BUN and the difference of vancomycin serum. Valley concentration were compared between the two groups before and after vancomycin treatment, and the correlation between the changes of CCR, SCR and BUN and vancomycin serum. Valley concentration was analyzed to explore the difference of clinical efficacy and adverse reaction rate between the two groups after treatment. Results: Two factor analysis of variance showed that the serum trough concentrations of SCR, bun and vancomycin in the intervention group were significantly lower than those in the routine treatment group, but the CCR value was significantly higher than that in the routine treatment group (P<0.05). Pearson correlation analysis showed that the serum. Valley concentration of vancomycin was negatively correlated with CCR (r=-0.473), but positively correlated with SCR (r=0.537) and bun (r=0.619) (P < 0.05) more.


Keywords

renal function; vancomycin; methicillin resistant staphylococcus aureus; pneumonia patients


References

1. Lakhundi S, Zhang K. Methicillin-resistant Staphylococcus aureus: molecular characterization, evolution and epi- demiology[J]. Clin Microbiol Rev, 2018,31(4): e00020- 18.

2. Galán- Sánchez F, Pérez- Eslava M, Machuca J, et al. Staphylococcus aureus carriage in older populations in community residential care homes: prevalence and molec- ular characterization of MRSA isolates[J]. Enferm Infecc Microbiol Clin, 2019, 37(3): 172- 175.

3. Holmes NE, Tong SY, Davis JS. Treatment of methicillin-resistant Staphylococcus aureus: Vancomycin and beyond [J]. Semin Respir Crit Care Med, 2015, 36(1):17-30.

4. Liu Junna, Wang Chunjuan, Fu guopeng Clinical characteristics and drug resistance of MRSA pneumonia [J] Clinical medicine research and practice, 2017, 2 (26): 34-35

5. Álvarez R, López Cortés LE, Molina J, et al. Optimizing the clinical use of vancomycin[J]. Antimicrob Agents Che- mother, 2016, 60(5): 2601-9.

6. Li Guanghui Consensus of Chinese experts on clinical dosage of vancomycin [J] Chinese Journal of infectious diseases, 2012 (11): 641-646

7. Velez JCQ, Obadan NO, Kaushal A, et al. Vancomycin-associated acute kidney injury with a steep rise in serum cre- atinine[J]. Nephron, 2018, 139(2): 131- 142.

8. Qu Jieming, Cao Bin. Guidelines for the diagnosis and treatment of community-acquired pneumonia in Chinese adults (2016 Edition) [J] Chinese Journal of tuberculosis and respiration, 2016, 39 (4): 253-279

9. Zhang Jing, Zhang Qi, Geng Jing. Analysis of epidemiological change trend of MRSA in hospitalized patients from 2012 to 2017 [J] Chinese Journal of nosocomial infection, 2018, 28 (19): 3033-3036

10. Wang Bin, Shi Youquan, Si Yiran, et al Research Progress on epidemiological characteristics of methicillin resistant Staphylococcus aureus [J] Journal of Dalian Medical University, 2013, 35 (2): 183 - 187

11. Mei H, Wang J, Che H. The clinical efficacy and safety of vancomycin loading dose: a systematic review and meta- analysis[J]. Medicine (Baltimore), 2019, 98(43): e17639.

12. Gong Xingjun Detection of vancomycin plasma concentration and its guiding significance for clinical medication [J] China’s health industry, 2017, 14 (9): 137-138

13. Vandecasteele SJ, De Vriese AS, Tacconelli E. The phar-macokinetics and pharmacodynamics of vancomycin in clinical practice: evidence and uncertainties[J]. J Antimi-crob Chemother, 2013, 68(4): 743-748.

14. Xia Lan, Ye Qianqian, Wu Anhua, et al. Effects of renal hyperfunction and hypoproteinemia on the concentration of vancomycin Valley [J] Chinese Journal of antibiotics, 2020, 45 (9): 940-946

15. Zhou Qingtao, He Bei, Shen Ning, et al Effect of renal clearance on vancomycin Valley concentration in elderly patients with severe pneumonia [J] Chinese Journal of tuberculosis and respiration, 2016, 39 (2): 105 - 109

16. Xie Ling, Liu Daihua, Huang Yikun Clinical intervention effect of vancomycin in patients with renal injury [J] Guangxi Medical Journal, 2018, 40 (19): 2272-2274

17. Moffett BS, Morris J, Kam C, et al. Vancomycin associat- ed acute kidney injury in pediatric patients[J]. PLoS One, 2018, 13(10): e0202439.

18. Arihan O, Wernly B, Lichtenauer M, et al. Blood urea ni- trogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU[J]. PLoS One, 2018, 13(1): e0191697.

Refbacks

  • There are currently no refbacks.


Copyright (c) 2023 Feng Hui

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


This site is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).