PDF(Pubmed)
Abstract：
In patients receiving vancomycin therapy, serum drug levels are routinely monitored to ensure therapeutic dosing and minimize toxicity. In rare cases, vancomycin levels may be falsely or persistently elevated without any apparent cause. In this case report, we explore a rare case of persistently elevated vancomycin levels despite discontinuation of the drug for days. This is a case of a 69-year-old female admitted for altered mental status secondary to sepsis from leg cellulitis. Antibiotic therapy included vancomycin. To ensure proper dosing, vancomycin trough levels were collected before the fourth dose, and the result showed a high value of 39 ug/ml. Vancomycin doses were adjusted as per the Bayesian dosing software, and the same remained to be in supratherapeutic levels. The patient eventually deteriorated, and due to persistently high vancomycin levels, the antibiotic regimen was switched to a different antibiotic. Despite normal renal functions, the vancomycin levels remained high, between 27 ug/ml and 32 ug/ml, even in the absence of any further doses. Subsequently, vancomycin serum concentration was determined by another method using high-performance liquid chromatography (HPLC). Blood cultures grew both coagulase-negative Staphylococcus aureus and Achromobacter xylosoxidans. Vancomycin levels remained high a week after discontinuation of the drug. Vancomycin by HPLC assay eventually showed that vancomycin was undetectable in the blood, but, unfortunately, the results came at a time when the patient had already expired. In conclusion, clinicians should maintain a high level of suspicion if persistently higher vancomycin levels cannot be accounted for by renal function or other causes. In patients with persistently high vancomycin levels who continue to clinically deteriorate, it is crucial to consider that assay interference can result in inaccurately elevated vancomycin levels.
摘要：
在接受万古霉素治疗的患者中，常规监测血清药物水平以确保治疗剂量并将毒性降至最低.在极少数情况下,万古霉素水平可能错误或持续升高，没有任何明显原因。在这个案例报告中,我们探索了一例罕见的万古霉素水平持续升高的病例,尽管停药数天.这是一例69岁的女性，因腿部蜂窝织炎败血症继发的精神状态改变而入院。抗生素治疗包括万古霉素。为了确保正确的剂量，在第四剂之前收集万古霉素谷水平，结果显示39ug/ml的高值。万古霉素剂量根据贝叶斯给药软件进行调整，和相同的仍然是超治疗水平。病人最终病情恶化，由于万古霉素水平持续高，抗生素治疗方案改为另一种抗生素.尽管肾功能正常,万古霉素水平仍然很高，在27ug/ml和32ug/ml之间，即使没有任何进一步的剂量。随后，万古霉素血清浓度通过另一种方法使用高效液相色谱法(HPLC)测定。血液培养物既生长了凝固酶阴性的金黄色葡萄球菌，又生长了木氧嗜酸性杆菌。万古霉素水平在停药一周后仍然很高。万古霉素经HPLC检测最终显示万古霉素在血液中检测不到，但是,不幸的是,结果是在患者已经过期的时候得出的。总之,如果万古霉素水平持续升高不能由肾功能或其他原因引起,临床医师应高度怀疑.在万古霉素水平持续升高并持续临床恶化的患者中，至关重要的是要考虑到分析干扰会导致万古霉素水平不准确升高。
