| 摘要: |
| 目的：研究耐甲氧西林金黄色葡萄球菌（MRSA）骨关节感染患儿的万古霉素谷浓度（Cmin）、给药24小时药时曲线下面积（AUC24）与最低抑菌浓度比值（MIC）与临床结局的关系。方法：选取2015年1月至2020年6月在佛山市中医院接受万古霉素治疗的MRSA骨关节感染儿童患者为研究对象，采集患者基本信息、临床疗效、万古霉素血药谷浓度、给药24小时药时曲线下面积以及最低抑菌浓度等数据，分析不同万古霉素血药谷浓度区间、AUC24/MIC区间与临床疗效及不良反应发生率的关系。采用受试者工作特征（ROC）曲线研究Cmin与AUC24/MIC与临床疗效的相关性。结果：共30例患儿纳入研究，血药谷浓度>10 mg/L组的治愈率（66.67%）与血药谷浓度<10 mg/L组（48.15%）比较差异无统计学意义（P>0.05）。AUC24/MIC≥400组的治愈率为81.82%，明显高于AUC24/MIC<400组的31.58%（P<0.05）。ROC曲线中，Cmin的ROC曲线下面积（0.92）较大。各万古霉素血药谷浓度分组间的不良反应发生率比较差异无统计学意义（P>0.05）。结论：MRSA骨关节感染儿童患者的万古霉素血药谷浓度≥10 mg/L并非是达到最佳疗效的必要条件，但万古霉素谷浓度需维持在5.25 mg/L以上；为保证疗效，有必要使AUC24/MIC≥400。但本研究涉及病例数较少，最佳血药谷浓度范围仍需进一步验证。 |
| 关键词: 万古霉素 骨关节感染 耐甲氧西林金黄色葡萄球菌 血药谷浓度 儿童 |
| DOI：doi:10.13407/ j.cnki.jpp.1672-108X.2022.02.004 |
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| 基金项目:基金项目:2018 年佛山市科学技术局科研项目,编号2018AB001751。 |
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| Correlation between Blood Concentration, 24-Hour Drug Time Area under the Curve and Clinical Outcome in Children with Orthopedic Infection Induced by Methicillin-Resistant Staphylococcus Aureus |
| Liang Biyi, Lu Fengshan, Yang Huixia |
| (Foshan Hospital of Traditional Chinese Medicine, Guangdong Foshan 528000, China) |
| Abstract: |
| Objective: To study the correlation between trough concentration (Cmin) of vancomycin, ratio of 24-hour drug time area under the curve (AUC24) and minimal inhibitory concentration (MIC), and clinical outcome in children with orthopedic infection induced by methicillin-resistant Staphylococcus aureus (MRSA). Methods: Children with orthopedic infection induced by MRSA who received vancomycin in Foshan Hospital of Traditional Chinese Medicine from Jan. 2015 to Jun. 2020 were selected as the research objects. General information, clinical efficacy, Cmin of vancomycin, AUC24 and MIC were collected. Correlation between different Cmin of vancomycin interval, AUC24/MIC interval and clinical efficacy and incidence of adverse drug reactions was analyzed. Receiver operating characteristic (ROC) curve was used to study the correlation between Cmin and AUC24/MIC and clinical efficacy. Results: A total of 30 children were enrolled. There was no significant difference in the cure rate between the Cmin >10 mg/L group (66.67%) and the Cmin <10 mg/L group (48.15%, P>0.05). The cure rate of AUC24/MIC ≥400 group was 81.82%, significantly higher than 31.58% of AUC24/MIC <400 group (P<0.05). In the ROC curve, the area (0.92) under the ROC curve of Cmin was larger. There was no significant difference in the incidence of adverse drug reactions among different Cmin of vancomycin groups (P>0.05). Conclusion: Cmin of vancomycin ≥10 mg/L in children with orthopedic infection induced by MRSA is not necessary for optimal efficacy, yet Cmin of vancomycin need to be maintained above 5.25 mg/L. To ensure efficacy, AUC24/MIC ≥400 is necessary. However, the sample size in this study is small and the optimal Cmin still needs further validation. |
| Key words: vancomycin orthopedic infection methicillin resistant Staphylococcus aureus trough concentration children |
