Objective: This study was designed to investigate effectiveness of therapeutic drug monitoring (TDM) and impact indicator of vancomycin pharmacokinetics in abdominal cancer patients complicated with severe infectious disease. Methods: A total of 78 patients abdominal cancer patients complicated with severe infectious disease were included. Vancomycin serum trough concentrations were measured using the fluorescence polarization immunoassay (FPIA) method. The patients were divided into early and delayed groups based on whether they achieve the target concentration. And clinical factors were compared between two groups. Results: The average initial therapeutic dose of vancomycin was 15.18±3.29 mg/kg (q12h). Ultimately, we collected 78 patient‘s trough concentrations data. The research revealed that the abdominal cancer patients complicated with severe infectious disease had significantly lower initial vancomycin trough concentrations (median [IQR]: 6.90[5.28-11.20] mg/L) compared with the recommended standard goal vancomycin trough concentration (10-15 or 15-20 mg/L). Multiple regression analysis revealed that Cys-C was the most important variable for vancomycin target trough achievement. We divided patients into early and delayed groups based on whether the initial trough concentration achieved standard goal trough concentration. Although the clinical outcomes were similar between two groups, the duration of mechanical ventilation in Early group was considerably shorter compared with group Delayed group (χ2=4.532; p < 0.05; Fig 1E). Propensity score weighting further confirmed that the duration of mechanical ventilation (χ2=6.607; p < 0.05; Fig 1F) and vasoactive agent (χ2=6.106; p < 0.05; Fig 1D) was considerably shorter compared with group Delayed group. Conclusions: The steady-state initial vancomycin trough concentration was significantly reduced in abdominal cancer patients complicated with severe infectious disease. Higher initial dosage regimen is needed to ensure clinical effectiveness. The baseline Cys-C level measured prior to administration of vancomycin is suggested to be the most suitable parameter to predict whether vancomycin trough concentration is up to standard dosage. Early attainment of target concentration significantly improved hemodynamic stability and reduced duration of mechanical ventilation.
Background: Therapeutic drug monitoring (TDM) of vancomycin is widely recommended for clinical treatment. The purpose of this study was designed to investigate the clinical implication of vancomycin TDM in patients undergoing surgery for gastrointestinal cancer requiring mechanical ventilation.Methods: We included 78 patients who underwent surgery for gastrointestinal cancer. And all the patients included in this study were 18 years of age or older and were treated with intravenous vancomycin therapy for more than 2 days due to documented or suspected gram-positive bacterial infections, and have at least one available vancomycin plasma concentration. Based on whether the initial vancomycin concentration achieved the target trough concentration, the patients were divided into early and delayed groups and the clinical factors were compared between two groups.Results: The research revealed that the patients undergoing surgery for gastrointestinal cancer had significantly lower initial vancomycin trough concentrations (median [IQR]: 6.90[5.28-11.20] mg/L). The duration of mechanical ventilation in early group was considerably shorter compared with delayed group (χ2=4.532; p < 0.05; Fig 2E). Propensity score weighting further confirmed that the duration of mechanical ventilation (χ2=6.607; p < 0.05; Fig 2F) and duration of vasoactive agent (χ2=6.106; p < 0.05; Fig 2D) was considerably shorter compared with delayed group. Multivariate regression analysis revealed that the Cys-C was the most important variable for vancomycin target trough achievement (odds ratio, 5.274; 95% CI, 1.780 to 15.627; p=0.003)Conclusions: The serum initial trough concentration of vancomycin was significantly reduced in patients undergoing surgery for gastrointestinal cancer. Minimizing the time to initial vancomycin target trough can improve clinical outcomes in Gram-positive bacterial infections. The Cystatin C (Cys-C) level is a potentially valuable parameter for predicting the vancomycin concentration and Cys-C inclusive dosing model is warranted.
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