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Publicação:
Vancomycin for dialytic therapy in critically ill patients: Analysis of its reduction and the factors associated with subtherapeutic concentrations

dc.contributor.authorde Freitas, Fernanda Moreira [UNESP]
dc.contributor.authorZamoner, Welder [UNESP]
dc.contributor.authorDos Reis, Pamela Falbo [UNESP]
dc.contributor.authorBalbi, André Luís [UNESP]
dc.contributor.authorPonce, Daniela [UNESP]
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.date.accessioned2021-06-25T10:33:36Z
dc.date.available2021-06-25T10:33:36Z
dc.date.issued2020-09-02
dc.description.abstractThis study aimed to evaluate the reduction in vancomycin through intermittent haemodialysis (IHD) and prolonged haemodialysis (PHD) in acute kidney injury (AKI) patients with sepsis and to identify the variables associated with subtherapeutic concentrations. A prospective study was performed in patients admitted at an intensive care unit (ICU) of a Brazilian hospital. Blood samples were collected at the start of dialytic therapy, after 2 and 4 h of treatment and at the end of therapy to determine the serum concentration of vancomycin and thus perform pharmacokinetic evaluation and PK/PD modelling. Twenty-seven patients treated with IHD, 17 treated with PHD for 6 h and 11 treated with PHD for 10 h were included. The reduction in serum concentrations of vancomycin after 2 h of therapy was 26.65 ± 12.64% and at the end of dialysis was 45.78 ± 12.79%, higher in the 10-h PHD group, 57.70% (40, 48–64, 30%) (p = 0.037). The ratio of the area under the curve to minimal inhibitory concentration (AUC/MIC) at 24 h in the PHD group was significantly smaller than at 10 h (p = 0.047). In the logistic regression, PHD was a risk factor for an AUC/MIC ratio less than 400 (OR = 11.59, p = 0.033), while a higher serum concentration of vancomycin at T0 was a protective factor (OR = 0.791, p = 0.009). In conclusion, subtherapeutic concentrations of vancomycin in acute kidney injury (AKI) patients in dialysis were elevated and may be related to a higher risk of bacterial resistance and mortality, besides pointing out the necessity of additional doses of vancomycin during dialytic therapy, mainly in PHD.en
dc.description.affiliationInternal Medicine Botucatu School of Medicine—UNESP São Paulo State University Julio de Mesquita Filho, Distrito de Rubiao Junior, Botucatu P.O. 18618687
dc.description.affiliationUnespInternal Medicine Botucatu School of Medicine—UNESP São Paulo State University Julio de Mesquita Filho, Distrito de Rubiao Junior, Botucatu P.O. 18618687
dc.description.sponsorshipUniversidade Estadual Paulista
dc.description.sponsorshipFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.description.sponsorshipIdFAPESP: 2017/02311-4
dc.format.extent1-12
dc.identifierhttp://dx.doi.org/10.3390/ijerph17186861
dc.identifier.citationInternational Journal of Environmental Research and Public Health, v. 17, n. 18, p. 1-12, 2020.
dc.identifier.doi10.3390/ijerph17186861
dc.identifier.issn1660-4601
dc.identifier.issn1661-7827
dc.identifier.scopus2-s2.0-85091097859
dc.identifier.urihttp://hdl.handle.net/11449/206519
dc.language.isoeng
dc.relation.ispartofInternational Journal of Environmental Research and Public Health
dc.sourceScopus
dc.subjectAcute kidney injury
dc.subjectDialysis
dc.subjectPharmacokinetic-pharmacodynamic
dc.subjectSepsis
dc.subjectVancomycin
dc.titleVancomycin for dialytic therapy in critically ill patients: Analysis of its reduction and the factors associated with subtherapeutic concentrationsen
dc.typeArtigo
dspace.entity.typePublication
unesp.campusUniversidade Estadual Paulista (UNESP), Faculdade de Medicina, Botucatupt
unesp.departmentClínica Médica - FMBpt

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