Avaliação do nível sérico de vancomicina em pacientes internados em centro de terapia intensiva pediátrica em um hospital terciário
Arquivos
Data
2017-11-20
Autores
Maloni, Talita Muniz 
Orientadores
Furtado, Guilherme Henrique Campos
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Infecções por Staphylococcus aureus resistente a oxacilina estão associadas com significativa morbidade e custos hospitalares. A vancomicina é um antibiótico glicopeptídeo, amplamente utilizado para o tratamento de infecções graves por microorganismos gram-positivos, principalmente Staphylococcus aureus resistente a oxacilina. Recomenda-se que os níveis séricos de vancomicina variem entre 10mg/L-20mg/L para otimizar sua eficácia e evitar o desenvolvimento de resistência bacteriana. Manter o nível sérico alvo de 15-20mg/L é recomendado para tratamento de infecções mais graves, em adultos, a concentração mínima de vancomicina de 15-20mg/L foi correlacionado com ASC/CIM>400, alvo farmacodinâmico que melhor prediz a eficácia da vancomicina. Apesar do extenso uso, informações ideais sobre posologia na população pediátrica permanecem limitadas. Dado o risco de prejuízo ao tratamento com vancomicina quando o paciente não atinge o nível sérico alvo, avaliamos a prevalência de pacientes pediátricos que não atingiram os níveis séricos de vancomicina adequados após administração da posologia recomendada. Além disso, investigamos a influência da idade, balanço hidrico positivo e uso de drogas vasoativas na capacidade destes pacientes atingirem os níveis alvo. Usamos um delineamento retrospectivo, observacional, em pacientes internados na Unidade de Terapia Intensiva Pediátrica do Hospital Israelita Albert Einstein no período de 1 de janeiro de 2008 a 31 de dezembro de 2014, para avaliar se o nível sérico da vancomicina coletado no vale estava dentro da faixa terapêutica (10-20mg/L). O perfil dos pacientes que utilizaram vancomicina também foi avaliado. Nosso estudo mostrou que na primeira coleta de vancocinemia 71,9% dos pacientes apresentaram nível sérico abaixo de 10mg/L, e somente 27,1% atingiram o nível 10-20mg/L. Considerando o tratamento completo, com todas as doses utlizadas, o nível sérico alvo também não foi atingido na maioria dos pacientes, 69% dos pacientes apresentaram nível sérico <10mg/L, ainda que 84% das coletas tenham sido realizadas no vale, conforme preconizado, a mediana da posologia tanto na primeira dose quanto no tratamento completo foi 40mg/kg/dia. Estes resultados enfatizam a necessidade de revisão das doses propostas e revisão do nível sérico alvo para atingir ASC/CIM>400 na população pediátrica.
Methicillin-resistant Staphylococcus aureus are associated with high morbidity and hospital costs. The vancomycin is a glycopeptide antibiotic that is widely used in pediatrics to treat infections caused by gram positive and mostly methicillin-resistant Staphylococcus aureus. It is recommended trough concentration of 10mg/L-20mg/L to optimize vancomycin efficacy and avoid development of bacterial resistance. In adults, a vancomycin trough concentration of 15–20 mg/L has been correlated with the AUC/ MIC> 400. goal. Despite the extensive use, ideal dosing information in the pediatric population remains limited. Because the risk failure of vancomycin treatment when the patient does not reach trough concentration after steady state, we evaluated the prevalence of pediatrics patients in the intensive care unit that did not achieve the appropriate vancomycin trough concentrations after administration of the recommended dosage. In addition, we investigated the influence of age, positive water balance and use of vasoactive drugs on the ability of these patients to reach target levels. This study is a retrospective cohort that included pediatrics patients in intensive care unit from Hospital Albert Einstein, a private general hospital focused on the treatment of highly complex diseases, located in São Paulo – Brazil, to evaluate if the vancomycin trough concentration were in the therapeutic range (10–20mg/L) during January 1, 2008 to December 31, 2014. The results shows that in the first moment 71.9% of the patients had trough concentration below 10mg/L, and only 27.1% reached trough concentration of 10-20mg/L. Considering the complete treatment, with all the doses used, the target was also not reached in the majority of the patients, 69% of the patients presented trough concentration <10mg/L, although 84% of the samples were taken 60 minutes before the next dose, as recommended, the median dose in both the first and full doses was 40 mg/kg/day. These results emphasize the need to review the proposed doses and review the target trough concentration to achieve AUC/MIC> 400 in the pediatric population.
Methicillin-resistant Staphylococcus aureus are associated with high morbidity and hospital costs. The vancomycin is a glycopeptide antibiotic that is widely used in pediatrics to treat infections caused by gram positive and mostly methicillin-resistant Staphylococcus aureus. It is recommended trough concentration of 10mg/L-20mg/L to optimize vancomycin efficacy and avoid development of bacterial resistance. In adults, a vancomycin trough concentration of 15–20 mg/L has been correlated with the AUC/ MIC> 400. goal. Despite the extensive use, ideal dosing information in the pediatric population remains limited. Because the risk failure of vancomycin treatment when the patient does not reach trough concentration after steady state, we evaluated the prevalence of pediatrics patients in the intensive care unit that did not achieve the appropriate vancomycin trough concentrations after administration of the recommended dosage. In addition, we investigated the influence of age, positive water balance and use of vasoactive drugs on the ability of these patients to reach target levels. This study is a retrospective cohort that included pediatrics patients in intensive care unit from Hospital Albert Einstein, a private general hospital focused on the treatment of highly complex diseases, located in São Paulo – Brazil, to evaluate if the vancomycin trough concentration were in the therapeutic range (10–20mg/L) during January 1, 2008 to December 31, 2014. The results shows that in the first moment 71.9% of the patients had trough concentration below 10mg/L, and only 27.1% reached trough concentration of 10-20mg/L. Considering the complete treatment, with all the doses used, the target was also not reached in the majority of the patients, 69% of the patients presented trough concentration <10mg/L, although 84% of the samples were taken 60 minutes before the next dose, as recommended, the median dose in both the first and full doses was 40 mg/kg/day. These results emphasize the need to review the proposed doses and review the target trough concentration to achieve AUC/MIC> 400 in the pediatric population.
Descrição
Citação
MIRANDA, Talita Muniz Maloni. Avaliação do nível sérico de vancomicina em pacientes internados em centro de terapia intensiva pediátrica em um hospital terciário. São Paulo, 2017. [82] p. Dissertação (Mestrado em Infectologia) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2017.