Nghiên cứu đánh giá quy trình giám sát nồng độ vancomycin trong máu trên bệnh nhân người lớn tại Bệnh viện Trung ương Quân đội 108

Abstract

Objective: To develop a vancomycin therapeutic drug monitoring protocol. To initially assess the effectiveness of the protocol. Subject and method: Vancomycin therapeutic drug monitoring protocol was developed by Focus Group Discussion method. A prospectively and interventional study was conducted on 14 patients who was indicated vancomycin infusion between 1/3/2021 - 15/4/2021 to evaluate the developed protocol. Result: Standard operating procedure for therapeutic monitoring of vancomycin in adult patients at 108 Military Central Hospital was developed with important content (treatment targets of vancomycin, vancomycin dosing, vancomycin therapeutic drug concentration monitoring). Initially assess the effectiveness of the standard operating procedure on 14 patients: Mean age of patients was 66.5 years, 71.4% of patients were male. Vancomycin was prescribed definitely higher than empirically (57.1% vs 42.9%). 64.3% of patients were prescribed loading dose. The average total time of vancomycin use was 11 days. The model based on Bauer model predicted the observed vancomycin concentration with reasonable forecasting (MAPE = 33.58%). The one-compartment PK model accurately predicted the observed vancomycin concentration (MAPE = 8.91% < 10%). Cumulative PK/PD target attainment proportion increased after first adjustment (64.3% vs 14.3%). After three adjustments, all of patients (need adjusted) achieved PK/PD target. Nephrotoxicity was occurred in 2 patients (18.2%). Conclusion: Protocol for therapeutic monitoring of vancomycin was developed (both intermittent infusion and continuous infusion). Protocol for therapeutic monitoring of vancomycin can be applied to patient population at 108 Military Central Hospital. Cumulative PK/PD target attainment proportion significantly increased after the first adjustment (64.3% vs 14.3%).