PDF(Pubmed)
Abstract：
BACKGROUND: CKD patients on hemodialysis (HD) with Staphylococcus aureus (SA) bacteremia present high morbidity, mortality and increased risk of MRSA. Vancomycin is the antibiotic of choice in these cases, it has a narrow therapeutic margin and inadequate dosage generates a risk of toxicity, therefore, the recommendation is to dosage it through serum levels.
METHODS: This is a retrospective cohort study in 3 hospitals of third level of complexity in the city of Medellin in which there were differences in the measurement and implementation of vancomycin25 dosage based on trough levels (VL) in patients with chronic kidney disease on hemodialysis (CKD- HD) with uncomplicated bacteremia based infection by methilcillin-resistant Staphyloccocus aureus (MRSA). The primary outcome was the composite of hospital mortality, clinical response (fever, hemodynamic instability and altered consciousness), complications associated with bacteremia, or bacteriological response failure (positive cultures at first week follow-up) at 7 days. The composite variables were analyzed individually as secondary outcomes.
RESULTS: The main unadjusted outcome (OR 1.3, CI 0.6 - 2.7) and adjusted for age, Charlson index, loading dose, initial dose, dosing frequency and MIC to vancomycin (OR 1.2, CI 0.5 - 2.7). Regarding adjusted secondary outcomes: clinical response (OR 1.4 CI 0.3 - 5.8), death (OR 1.3 CI 0.3 - 4.6) and complications (OR 0.9, CI 0.37 - 2.2).
CONCLUSIONS: We conclude that the measurement of trough levels in patients with HD-CKD does not modify the composite outcome. The main limitation is the sample size and type of study, randomized control trials may be required to confirm the results presented.
METHODS: This is a retrospective cohort study in 3 hospitals of third level of complexity in the city of Medellin in which there were differences in the measurement and implementation of vancomycin25 dosage based on trough levels (VL) in patients with chronic kidney disease on hemodialysis (CKD- HD) with uncomplicated bacteremia based infection by methilcillin-resistant Staphyloccocus aureus (MRSA). The primary outcome was the composite of hospital mortality, clinical response (fever, hemodynamic instability and altered consciousness), complications associated with bacteremia, or bacteriological response failure (positive cultures at first week follow-up) at 7 days. The composite variables were analyzed individually as secondary outcomes.
RESULTS: The main unadjusted outcome (OR 1.3, CI 0.6 - 2.7) and adjusted for age, Charlson index, loading dose, initial dose, dosing frequency and MIC to vancomycin (OR 1.2, CI 0.5 - 2.7). Regarding adjusted secondary outcomes: clinical response (OR 1.4 CI 0.3 - 5.8), death (OR 1.3 CI 0.3 - 4.6) and complications (OR 0.9, CI 0.37 - 2.2).
CONCLUSIONS: We conclude that the measurement of trough levels in patients with HD-CKD does not modify the composite outcome. The main limitation is the sample size and type of study, randomized control trials may be required to confirm the results presented.
摘要：
背景：患有金黄色葡萄球菌（SA）菌血症的血液透析（HD）CKD患者发病率高，死亡率和MRSA风险增加。万古霉素是这些病例的首选抗生素，它的治疗范围狭窄，剂量不足会产生毒性风险，因此,建议通过血清水平给药。
方法：这是一项在麦德林市3家三级复杂医院进行的回顾性队列研究，其中基于谷值水平（VL）的vancomycin25剂量的测量和实施存在差异。慢性肾病患者进行血液透析（CKD-HD）并伴有甲氧西林耐药金黄色葡萄球菌（MRSA）感染的简单菌血症。主要结局是医院死亡率的复合结果，临床反应(发烧，血流动力学不稳定和意识改变)，与菌血症相关的并发症，或7天的细菌学反应失败（第一周随访时的阳性培养物）。将复合变量作为次要结果进行单独分析。
结果：主要的未调整结果（OR1.3，CI0.6-2.7）并根据年龄进行了调整，Charlson指数,负荷剂量,初始剂量,给药频率和对万古霉素的MIC（OR1.2，CI0.5-2.7）。关于调整后的次要结局：临床反应（OR1.4CI0.3-5.8），死亡（OR1.3CI0.3-4.6）和并发症（OR0.9，CI0.37-2.2）。
结论：我们得出的结论是，HD-CKD患者的谷值测量不会改变复合结局。主要限制是研究的样本量和类型，可能需要随机对照试验来确认所提出的结果.
方法：这是一项在麦德林市3家三级复杂医院进行的回顾性队列研究，其中基于谷值水平（VL）的vancomycin25剂量的测量和实施存在差异。慢性肾病患者进行血液透析（CKD-HD）并伴有甲氧西林耐药金黄色葡萄球菌（MRSA）感染的简单菌血症。主要结局是医院死亡率的复合结果，临床反应(发烧，血流动力学不稳定和意识改变)，与菌血症相关的并发症，或7天的细菌学反应失败（第一周随访时的阳性培养物）。将复合变量作为次要结果进行单独分析。
结果：主要的未调整结果（OR1.3，CI0.6-2.7）并根据年龄进行了调整，Charlson指数,负荷剂量,初始剂量,给药频率和对万古霉素的MIC（OR1.2，CI0.5-2.7）。关于调整后的次要结局：临床反应（OR1.4CI0.3-5.8），死亡（OR1.3CI0.3-4.6）和并发症（OR0.9，CI0.37-2.2）。
结论：我们得出的结论是，HD-CKD患者的谷值测量不会改变复合结局。主要限制是研究的样本量和类型，可能需要随机对照试验来确认所提出的结果.
