溶出伏安法检测尿碘的方法学评价

目的验证溶出伏安法测定尿碘的临床应用性能。方法采用SR-I-100尿碘专用型微量元素检测仪(溶出伏安法)测定人尿冻干粉和尿临床样本,验证溶出伏安法的正确度、精密度、线性、交叉污染、最低检测限,并与过硫酸铵消化-砷铈催化分光光度法进行比较。结果溶出伏安法测定低(104μg/L)、高(486μg/L)浓度人尿冻干粉的相对偏倚分别为-1.76%和3.62%;测定低(80.89μg/L)、中(210.33μg/L)、高(538.50μg/L)3个浓度尿样本的变异系数(CV)分别为9.81%、4.27%、3.64%;尿碘浓度在100~540μg/L时检测呈线性,线性回归方程为Y=88.525X-6.678 0,R~2=0.993 1;样本间不存在交叉污染;检测低限为50μg/L(CV=12.85%)。溶出伏安法与过硫酸铵消化-砷铈催化分光光度法的测定结果差异无统计学意义(P0.05),且相关性良好(R~2=0.97)。结论溶出伏安法测定尿碘有良好的正确度、精密度、线性和检测限,不存在交叉污染,可在临床上推广应用。     

血清总同型半胱氨酸候选参考测量程序(液相色谱串联质谱法)的建立及性能评估

目的建立一种基于液相色谱串联质谱(LC-MS/MS)技术的血清总同型半胱氨酸(Hcy)候选参考测量程序并对其性能进行评价。方法采用一种简单的蛋白沉淀方法对血清样本进行前处理,然后采用LC-MS/MS定量检测总Hcy,参照美国临床实验室标准化协会(CLSI) C62-A文件和C50-A文件对建立的候选参考方法进行线性、检测限与定量限、基质效应、精密度、正确度等基本分析性能验证。结果 LC-MS/MS检测总Hcy的线性范围为0.5～200.0μmol/L。定量限和检测限分别为0.31 nmol/g、0.06 nmol/g。3种不同比例(1∶1、80∶20、20∶80)的血清与溶液混合物的相对基质效应分别为1.94%、1.91%、1.78%。批内、批间变异系数(CV)分别为2%和1%。3种浓度(30.58、49.21、65.42 nmol/g)的加标样本平均加标回收率分别为99.8%、100.2%、100.8%。测定NIST SRM 1950标准物质的结果偏移1%。样本处理后分别在室温[(23±2)℃]和自动进样器(温度为10℃)中放置24 h,检测结果均非常稳定。结论成功建立了基于LC-MS/MS技术的血清总Hcy候选参考测量程序。该参考测量程序准确度高、精密度好,能够用于常规临床检验方法的量值溯源,保证测定结果的准确性。     

UHPLC法检测血清中万古霉素的浓度

目的 建立通过超高效液相色谱（UHPLC）检测血清中万古霉素浓度的方法,指导临床安全合理用药.方法 使用Agilent 1290超高效液相色谱平台,采用Angilent Zorbax SB-Aq色谱柱（2.1 mm×50 mm,1.8 μm）,以乙腈∶水（体积比为10∶90）为流动相进行梯度洗脱,检测波长为230 nm,柱温30 ℃,流速0.4 mL/min,进样量1 μL.结果 万古霉素在5~100 μg/mL质量浓度范围内线性良好（r=0.998 7）,检测下限为1 μg/mL.检测低浓度（5 μg/mL）、中浓度（60 μg/mL）、高浓度（90 μg/mL）三个浓度值的平均方法回收率均大于90%,各浓度值得日内、日内相对标准偏差（RSD）均小于8%.结论 利用UHPLC可以快速准确的检测血清中万古霉素的浓度.     

Architect i2000免疫分析仪测定血清肿瘤标志物甲胎蛋白、CA125的初步评价

目的:对Architect i2000免疫分析仪定量检测肿瘤标志物的方法学予以初步评价。方法:根据美国临床实验室标准化委员会颁布的《定量临床检验方法的初步评价:批准指南(EP10-A)》提供的方法,按照特定顺序连续5d测定低、中、高浓度人混合血清中的甲胎蛋白(AFP)、CA125浓度。计算偏差、总不精密度及其截距、斜率、非线性、携带污染和漂移,并进行t检验。结果:3种浓度AFP的绝对偏差为低值-0.29μg/L、中值-6.33μg/L、高值-8.63μg/L,均低于允许偏差的±2.109μg/L、±31.032μg/L、±63.72μg/L。3种浓度CA125的绝对偏差为低值-0.79IU/mL、中值-4.73IU/mL、高值-4.17IU/mL,均低于允许偏差的±3.381IU/mL、±34.494IU/mL、±39.315IU/mL。3种浓度AFP总不精密度批内变异系数(CV)分别为3.755%、2.622%、2.617%,均小于厂家说明书规定的10%。中、高两种浓度CA125总不精密度CV分别为5.693%、3.482%,均小于全国临床检验操作规程规定的允许不精密度6.8%,低浓度CA125的总不精密度...     

胶乳增强免疫比浊法测定胃蛋白酶原Ⅱ的不精密度和线性观察

目的对胶乳增强免疫比浊法测定胃蛋白酶原Ⅱ(PGⅡ)进行初步方法学评价,为临床应用提供依据。方法依据美国临床实验室标准化委员会(NCCLS)EP5-A及EP10-A2文件提供的方法,对胶乳增强免疫比浊法测定PGⅡ进行初步的评价。结果 PGⅡ的低值样本批内变异系数(CV)为2.05%、批间CV为1.60%、日间CV为3.92%、总CV为4.70%;高值样本批内CV为1.70%、批间CV为1.21%、日间CV为3.79%、总CV为4.32%。当PGⅡ浓度分别为9.6、24.7、39.8μg/L时,相对偏倚分别为-0.18、-0.47、-0.39μg/L,总不精密度分别为4.98%、2.39%、2.71%。测试间的携带污染差异无统计学意义(P>0.05)。线性回归方程为Y=0.975 7X-0.016 8,决定系数(R2)=0.998 7。结论胶乳增强免疫比浊法测定PGⅡ的精密度符合EP5-A文件标准,具有良好的重复性。线性、偏倚、总不精密度及抗交叉污染能力均达到EP10-A2文件标准,符合临床应用要求,适用于实验室常规测定。     

LC-MS/MS法同时测定欧前胡素与异欧前胡素血药浓度

目的建立可同时测定欧前胡素与异欧前胡素血药浓度的液质联用-质谱串联法(LC-MS/MS)。方法以地西泮为内标,血浆样品经乙酸乙酯萃取后经超高效液相色谱(Acquity UPLC)BEH C18色谱柱(2.1×100 mm,1.7μm)分离,欧前胡素与异欧前胡素在质谱条件为正电喷雾电离(ESI~+)(m/z:271.5204.2),锥孔电压为20 V,碰撞能量为33 V,考察特异性、线性范围、定量下限、基质效应以及方法学回收率、精密度和稳定性。结果欧前胡素与异欧前胡素保留时间分别约1.5 min及2.4 min,欧前胡素浓度在0.1～20 ng/mL范围内线性良好(r~2=0.998 2),定量下限0.1 ng/mL(信噪比S/N10)。异欧前胡素浓度在0.05～10 ng/mL范围内线性良好(r~2=0.998 9),定量下限0.05 ng/mL(S/N10),基质效应为94.89%～110.70%,方法学回收率为94.3%～104.3%。欧前胡素与异欧前胡素的重复性以CV表示,CV分别4.91%、5.26%,期间CV分别16.39%、14.87%。冻融条件下二者CV均不大于7.21%,室温下均不大于10.44%。结论建立了同时测定欧前胡素与异欧前胡素血药浓度的LC-MS/MS法,该法灵敏度高、特异性好、稳定性好。     

液质联用色谱测定聚丙烯酰胺水凝胶中丙烯酰胺含量

目的探讨聚丙烯酰胺水凝胶中丙烯酰胺含量的可靠测定方法。方法采用液质联用色谱(HPLC-MS/MS)和同位素稀释定量技术,以选择反应监测(SRM)方式测定医用聚丙烯酰胺样本及20例聚丙烯酰胺临床样本中的丙烯酰胺含量。以丙烯酰胺标准品为对照,样本经水溶液振荡提取,硅藻土柱净化。色谱条件:MG120 C18色谱柱(5μm粒径,150 mm×4.6 mm),柱温均26℃;流动相为甲醇∶0.1%甲酸=1∶9,流速为0.6 mL/min;进样量为10μL。结果丙烯酰胺分离良好。峰面积与浓度呈良好的线性关系,线性范围可达3 000μg/L。加标水平在50μg/L时,回收率为103.1%,相对标准差(RSD)为6.20%。医用聚丙烯酰胺样本中丙烯酰胺含量为3.9×10-9~3.1×10-8g/L。20例聚丙烯酰胺临床样本中丙烯酰胺含量为(14.39±6.40)×10-9g/L。结论该方法样本处理简单,准确度高,灵敏度高,适合聚丙烯酰胺水凝胶中丙烯酰胺含量的测定。     

人血清哇巴因UPLC-MS/MS检测方法的建立和方法比对

目的建立超高效液相色谱串联质谱(UPLC-MS/MS)检测人血清哇巴因的方法。方法采用高特异性的UPLC-MS/MS,以氘标记的哇巴因-d3作为内标。样本采用固相萃取(SPE)前处理方法,以反相色谱柱负离子模式及电喷雾电离源(ESI)检测血清哇巴因水平。对建立的方法进行方法学(基质效应、回收率、准确度、批内精密度、批间精密度及稳定性)验证。采用建立的UPLC-MS/MS方法检测20名体检健康者及40例高血压患者血清哇巴因水平,并与酶联免疫吸附试验(ELISA)进行比较。结果 UPLC-MS/MS检测血清哇巴因的标准曲线范围为0.02～5.0 ng/mL,最低定量检测限(LLOQ)为0.02ng/mL。采用ABN固相萃取小柱进行样本前处理的基质效应较小,且回收率较高,达85%。LLOQ和低值(0.06 ng/mL)、中值(0.6 ng/mL)、高值(4 ng/mL)质控品的准确度分别为108.0%、89.2%、101.0%、103.0%。3个水平质控品的批内变异系数(CV)分别为2.87%、1.95%、0.56%,批间CV分别为5.98%、1.90%、0.75%。样本室温过夜放置16 h及样本前处理后室温放置自动进样器48 h的偏差均15%。采用UPLC-MS/MS检测哇巴因,正常对照者及高血压患者血清中均未检测到哇巴因。采用ELISA测定血清哇巴因,高血压患者为0.096 ng/mL,正常对照者为0.062 ng/mL。UPLC-MS/MS检测5个水平(0.02、0.05、0.10、0.20、0.50 ng/mL)的哇巴因标准品,其测定结果与对应的哇巴因标准品浓度呈正相关,且线性较好(r20.99),准确度较高;而ELISA检测5个水平哇巴因标准品的结果均很接近(0.024 9～0.029 6 ng/mL)。结论建立了检测人血清哇巴因的UPLC-MS/MS方法,未检测到正常人及高血压患者的血清哇巴因。UPLC-MS/MS与ELISA检测血清哇巴因的结果存在较大差异。     

LC-MS/MS法快速定量人血浆中克拉霉素的浓度

目的建立液相色谱串联质谱法测定人血浆中克拉霉素的浓度。方法选用ACQUITY UPLC BEH C18柱(2.1×50mm,1.7μm)的色谱柱,以含0.1%的甲酸纯水,含0.1%的甲酸95%乙腈为流动相,采用梯度洗脱进行分离,样本经蛋白沉淀及30%乙腈复溶后进样,选用API4000型质谱仪的多重反应监测(MRM)扫描方式进行检测。结果克拉霉素线性范围为4.00～2 000.00ng/mL,定量下限4.00ng/mL。准确度与精密度结果显相对偏差为1.20%～2.90%,低、中、高3个浓度提取回收率平均值均大于100%,基质效应小,稳定性好。结论该方法快速、灵敏、专属性强、重现性好,可用于人体克拉霉素血药浓度的监测及人体药代动力学研究。     

人凝血酶原复合物中磷酸三丁酯残留量检测方法验证

目的 建立气相色谱法测定人凝血酶原复合物中磷酸三丁酯残留量的方法,并进行方法验证。方法 采用酸改性聚二乙醇(20M)毛细管柱,正己烷为溶剂,各项色谱参数为：气化室温度220℃、柱温箱温度155℃、检测器温度220℃、柱流量为2.0 mL/min、载气为氮气、检测器FID、采集时间10 min,进行准确性、重复性、线性、专属性、中间精密度、检测限、定量限、范围、耐用性的方法验证。结果 验证结果显示该方法专属性良好;标准曲线的直线回归相关系数为0.999 90;在50%、100%、150%(100%水平浓度为30μg/mL)三个水平浓度的的回收率分别是98.4%、97.5%、95.7%,平均回收率为97.2%,相对偏差为2.15%;在水平浓度为100%重复性为2.08%,中间精密度的相对偏差为1.63%;检测限为0.255μg/mL,定量限为0.511μg/mL,在改换同一厂家同一型号不同批号的毛细色谱柱之后系统适用性实验满足要求,方法耐用性良好。结论 该方法能满足实验室人凝血酶原复合物磷酸三丁酯残留量的测定。     

Comparison of single trough-based area under the concentration–time curve versus trough concentration for the incidence of vancomycin-associated nephrotoxicity

IntroductionWhile the revised 2020 consensus guideline recommends the use of area under the concentration–time curve (AUC)-guided vancomycin monitoring, collecting multiple vancomycin serum samples to calculate the AUC may cause clinical complications. The aim of the present retrospective study was to evaluate whether AUC-guided vancomycin monitoring, in which AUC was calculated based on a single trough concentration, is a better predictor of nephrotoxicity than trough-guided monitoring in patients receiving vancomycin therapy.MethodsA single-center, retrospective cohort study was conducted at the 614-bed Gifu University Hospital in Japan. Patients who received intravenous vancomycin for a documented or suspected infection and had their serum vancomycin trough concentration monitored between October 1, 2016 and September 30, 2020 were enrolled in the present study.ResultsMultivariate Cox proportional hazard analysis indicated that AUC (>600 μg?h/mL) was a significant risk factor for the incidence of acute kidney injury (AKI), while trough concentration (≥15 μg/mL) was not. Moreover, the AUC (>600 μg?h/mL) showed higher specificity and similar sensitivity to the trough concentration (≥15 μg/mL). Kaplan-Meier plots of the cumulative incidence of the AKI-free rate in patients indicated that the onset of AKI was significantly longer in patients with AUC ≤600 μg?h/mL than in patients with AUC >600 μg?h/mL (HR, 16.1; 95% CI, 6.3–41.2; p < 0.001).ConclusionAUC based on a single trough concentration was a better predictor of nephrotoxicity than trough concentration.     

A correlation between reduced susceptibilities to vancomycin and daptomycin among the MRSA isolates selected in mutant selection window of both vancomycin and daptomycin

Guidelines for the treatment of MRSA infection, recently published by the IDSA and JSC, recommend daptomycin for sepsis and skin and soft tissue infections comparably to or more strongly than vancomycin. Meanwhile MIC creeping with an increased isolation frequency of MRSA isolates with vancomycin MIC of 2 μg/mL has become a problem. In the present study, the MIC creeping rate of MRSA strains in the Tohoku district, Japan in 2012 was 13%, a significantly higher value than 3.3% in 2008 (P < 0.01). Of these isolates, the MIC and mutant prevention concentration (MPC) values of daptomycin and vancomycin were determined for 30 clinical isolates of MRSA in 2012. The MIC₅₀/MIC₈₀ values of daptomycin and vancomycin were 0.125/0.5 μg/mL and 0.125/1 μg/mL, respectively. The MPC₅₀/MPC₈₀ values of daptomycin and vancomycin were both 32/64 μg/mL. In the present study, the mutant selection window (MSW) of daptomycin and vancomycin was ≥64 MIC. Of strains that selected in the MSW, daptomycin non-susceptible isolates accounted for 70.0%, while MRSA with vancomycin MIC of 2 μg/mL accounted for 26.7%. On the other hand, 50% of the strains that selected in the vancomycin MSW were daptomycin non-susceptible strain. The detection rate of MRSA with vancomycin MIC of 2 μg/mL that selected in the daptomycin MSW was 36.7%. These results showed that MRSA with vancomycin MIC of 2 μg/mL and daptomycin non-susceptible isolates were selected by exposure to both antibiotics. Therefore, though vancomycin is frequently used for treatment of MRSA infection, both antibiotics should be selected as a first-line drug appropriately.     

Vancomycin disposition following intraperitoneal administration in children receiving peritoneal dialysis.

BACKGROUND: Little information is available on the disposition of vancomycin during chronic peritoneal dialysis (PD) in children. The primary objective of this study was to investigate the disposition of vancomycin following intraperitoneal (IP) administration in children receiving short-dwell [e.g., automated PD (APD)] and long-dwell [e.g., continuous ambulatory PD (CAPD)] PD. METHODS: A 6-hour exchange containing vancomycin 500 mg/L, using an exchange volume of 1100 mL/m2 body surface area (BSA), was followed by 4-, 6-, and 8-hour antibiotic-free exchanges. The 8-hour exchange was followed by three to four 90-minute antibiotic-free exchanges. Serial blood and dialysis effluent samples were obtained and analyzed for vancomycin concentration by high-pressure liquid chromatography. Pharmacokinetic parameters were computed using noncompartmental methods. RESULTS: The bioavailability of vancomycin during a 6-hour IP exchange was 70% +/- 5%, resulting in a delivered dose of 12.0 +/- 1.8 mg/kg, and a 6-hour serum vancomycin concentration of 23.3 +/- 7.2 microg/mL. Total body vancomycin clearance measured 10.72 +/- 4.52 mL/minute/1.73 m2 BSA, while clearance attributable to PD measured 2.78 +/- 1.08 mL/min/1.73 m2 BSA and accounted for 29% +/- 11% of total vancomycin clearance. Dialysis clearance during long-dwell (CAPD) and short-dwell (APD) regimens was similar, measuring 2.46 +/- 1.04 and 3.09 +/- 1.28 mL/min/1.73 m2 BSA, accounting for 25% +/- 13% and 32% +/- 12% of total body clearance respectively. CONCLUSIONS: Intraperitoneal absorption and dialysis clearance of vancomycin in children receiving PD are similar to those reported in adult dialysis patients. In contrast, total body clearance of vancomycin appears to be increased and the elimination half-life decreased in children, due to increased elimination by non-renal nondialysis routes. For intermittent IP vancomycin therapy in children with peritonitis, an IP load containing vancomycin 1000 mg/L (or 30 mg/kg), followed a single full-fill (1100 mL/m2 BSA) daily exchange, containing vancomycin 250 mg/L (or 7.5 mg/kg), from day 2 until the end of treatment will maintain a vancomycin dialysate concentration of >4 microg/mL.     

分光光度法检测血清百草枯质量浓度及意义

目的 评价分光光度法测定血清百草枯(paraquat,PQ)质量浓度的可靠性及其临床意义。方法 验证普通分光光度法和二阶导数分光光度法测定血清PQ质量浓度的检测波长后,采用二阶导数分光光度法测定血清PQ质量浓度,确定其线性范围并评价其准确性;采用该法测定8例PQ中毒患者血清PQ质量浓度并与高效液相色谱法测定值比较分析其可靠性;对上海市第十人民医院肾病免疫科2008年10月至2010年9月收治的口服PQ4h以上人院的21例急性PQ中毒患者的资料行回顾性统计分析,根据该法测定患者入院时血清PQ质量浓度是否大于1.8 μ.g/mL分为两组,采用成组t检验和Fisher精确概率法对两组患者的临床特征进行统计分析。结果 (1)普通分光光度法检测含PQ血清样本时在257 nm波长处未见明显吸收峰;(2)二阶导数分光光度法测定血清PQ质量浓度在0.4～8.0 μg/mL范围内呈现良好的线性关系,相关系数为0.996;回收率为95.0％～99.5％,相对标准差(RSD)为1.35％～5.41％ (n=6),检出下限为0.05 μg/mL;(3)8例PQ中毒患者血清PQ质量浓度二阶导数分光光度法测定值与HPLC法检测值相吻合,r=0.995,P＜0.01;(4)血清PQ质量浓度＞1.8 μg/mL组患者存活率为22.2％,酸中毒和少尿发生率55.6％,纵膈气肿发生率77.8％,与血清PQ质量浓度＜1.8 μg/mL组比较差异均有统计学意义(P＜0.05)。结论 (1)普通分光光度法用于测定血清PQ质量浓度不能采用257 rn为检测波长;(2)二阶导数分光光度法用于检测血清百草枯质量浓度可靠性高;(3)二阶导数分光光度法测定值可用于中毒患者的临床严重程度判断,口服PQ中毒4h后血清质量浓度＞1.8 μg/mL是患者预后不良的重要指标。     

高效液相色谱法测定注射用奥沙利铂5％葡萄糖注射液中5-羟甲基糠醛的含量

目的采用高效液相色谱法测定注射用奥沙利铂5%葡萄糖注射液中的5-羟甲基糠醛的含量。方法采用高效液相色谱法测定注射用奥沙利铂5%葡萄糖注射液中的5-羟甲基糠醛的含量,用十八烷基键合硅胶色谱柱(型号:Unitary C18;孔径:100A;柱长:250 mm×4.6 mm;直径:5μm),流动相A为0.05 M磷酸二氢钾溶液,流动相B为乙腈,梯度洗脱,流速为1.0 mL/min,检测波长为284 nm,柱温30℃,进样体积20μL。结果5-羟甲基糠醛在0.0997~5.5016μg/mL浓度范围内线性关系良好(r=0.9998),加样回收率为99.18%,RSD为1.42%。结论经方法学验证,高效液相色谱法操作简便、精密度、准确度高,线性关系良好,重现性好,能满足注射用奥沙利铂在5%葡萄糖注射液中5-羟甲基糠醛的含量测定要求,可用于该产品的质量控制。     

RP-HPLC法同时测定人血清咪哒唑仑、阿普唑仑与氯硝安定药物浓度

【目的】建立一高效液相色谱法同时测定人血清中咪哒唑仑（MZ）、阿普唑仑（AZ）、氯硝安定（CZ）药物浓度,为临床用药及治疗提供依据。【方法】采用反相高效液相色谱法,色谱柱为依利特Kromasil C18柱（250mm×4．6mm,5μm）;柱温40℃;流动相为甲醇-水（65：35,v／v）,流速1．0mL／min;波长220nm。血液样品采用10％高氯酸沉淀蛋白后,直接进样20μL,测定,采用内标法定量。【结果】MDZ、AZ、CZ在0．025～10．00μg／mL浓度范围内线性关系好,相关系数分别为r=0．9994,0．9993,0．9991,最低检测限均为5．0ng／mL,三种物质的平均方法回收率均大于92．0％,相对标准偏差（RSD）〈4．1％。【结论】本法测定MZ、AZ、CZ的血药浓度方法简便、快速准确,可用于临床的常规监测。     

A retrospective analysis of possible renal toxicity associated with vancomycin in patients with health care-associated methicillin-resistant Staphylococcus aureus pneumonia

OBJECTIVE: The goal of this investigation was to determine whether more aggressive vancomycin dosing is associated with greater risk for renal toxicity in patients with health care-associated pneumonia (HCAP) attributed to methicillin-resistant Staphylococcus aureus (MRSA). METHODS: This was a retrospective, single-center, observational cohort study. The following information was obtained for all study patients from automated hospital, microbiology, and pharmacy databases: age, sex, weight, serial serum creatinine (SCr), age- and sex-adjusted creatinine clearance (CrCl) during receipt of vancomycin, vancomycin serum trough concentrations, duration of vancomycin therapy, and Acute Physiology and Chronic Health Evaluation II scores. Renal toxicity was defined as either a 0.5-mg/dL increase from baseline in SCr or a >or=50% increase in SCr based on serial SCr measurements. Data for patients who met the definition of renal toxicity were compared with data for those who did not. RESULTS: Ninety-four patients (mean [SD]age, 59.0 [15.6] years; 59 [62.8%] men; 73 (77.7%) white; mean baseline CrCl, 70.3 [23.0] mL/min) were identified as having MRSA HCAP. Forty (42.6%) patients developed renal toxicity. Patients who developed renal toxicity were significantly more likely than patients who did not develop renal toxicity to have greater mean vancomycin serum trough concentrations (20.8 [9.9] g/mL vs 14.3 [6.7] g/mL, respectively; P < 0.001), vancomycin serum trough concentrations >or=15 g/mL (67.5% vs 40.7%; P = 0.01), and a prolonged duration (>or=14 days) of vancomycin treatment (45.0% vs 20.4%; P = 0.011). Logistic regression analysis identified a maximum vancomycin serum trough concentration of >or=15 g/mL as being independently associated with renal toxicity (adjusted odds ratio = 2.82; 95% CI, 1.02-7.74; P = 0.045). The overall mean change in CrCl for the study population was -13.5 (-16.0) mL/min (range, 0.0 to -62.6 mL/min). Patients with maximum measured vancomycin serum trough concentrations >or=15 g/mL (n = 49) had significantly greater absolute changes in CrCl compared with patients with maximum measured vancomycin serum trough concentrations <15 g/mL (n = 45) (-18.9 [-17.0] vs -7.6 [-12.5] mL/min, respectively; P < 0.001). CONCLUSIONS: The results suggest that aggressive vancomycin dosing and prolonged vancomycin administration may be associated with greater risk for renal toxicity in patients with MRSA HCAP. However, this retrospective study cannot establish causation, and a prospective, randomized, double-blind trial is needed.     

酶放大免疫法与荧光免疫层析法检测万古霉素血液浓度的对比研究

目的 比较酶放大免疫法(enzyme-multiplied immunoassay technique,EMIT)和荧光免疫层析法(fluorescence immunochromatography assay,FICA)测定万古霉素血液浓度的结果及相关性分析.方法 收集2020年9月～11月需要进行万古霉素血液浓度检...     

酶联免疫吸附法检测血清舒芬太尼血药浓度的应用价值

目的探讨应用酶联免疫吸附法（ELISA）定量检测人血清舒芬太尼浓度及其在产妇镇痛分娩、婴儿脐带血血药浓度监测中的应用价值。方法应用ELISA两步法定量检测舒芬太尼浓度,拟合标准曲线,测定检测限,并检测自控椎管内镇痛分娩产妇和婴儿脐带血血清样本各48份,分别检测用药1、3、5h和脐带血的血药浓度。结果此方法绘制的舒芬太尼标准曲线为：Y=420.375 X＋32.043,1h血清舒芬太尼浓度为（0.087±0.013）μg/mL,3h舒芬太尼浓度为（0.026±0.011）μg/mL,5h舒芬太尼浓度为（0.011±0.050）μg/mL,脐带血血药浓度为（0.040±0.029）μg/mL。结论 ELISA方法测定人血舒芬太尼简便、快捷,血药浓度1h达峰值,分娩镇痛效果理想,可用于临床药动学研究。婴儿脐带血药物浓度极低,未见药物不良反应。     

Clinical efficacy of teicoplanin in the treatment of bloodstream infection caused by methicillin-resistant coagulase-negative staphylococci

Empirical combination therapy with β-lactams and glycopeptides is recommended for patients with presumed staphylococcal bloodstream infection (BSI). While coagulase-negative staphylococci (CNS) remain susceptible to vancomycin, such isolates have become less susceptible to teicoplanin. The aim of this retrospective study was to evaluate the clinical efficacy of teicoplanin in the treatment of BSI caused by methicillin-resistant CNS according to teicoplanin susceptibility. Inclusion criteria were patients with intravascular-catheter related BSIs caused by methicillin-resistant CNS (positive for two or more specimens); teicoplanin therapy; and at least one of the signs or symptoms caused by BSI. Antimicrobial resistance was defined as minimum inhibitory concentration (MIC) ≥8 μg/mL. The primary efficacy endpoint was clinical success evaluated 2 weeks after the completion of teicoplanin therapy [test of cure (TOC)]. Resistant rate of CNS was 0% for vancomycin and 22.9% for teicoplanin, and geometric mean MICs were 1.31 μg/mL and 3.41 μg/mL, respectively (p < 0.001). The catheter was removed in all patients except one, and high early clinical response at 72 h after starting therapy was obtained irrespective of teicoplanin susceptibility. The clinical success rate at TOC was 60% in patients with BSIs caused by teicoplanin-resistant strains, while 90% in patients with BSIs caused by susceptible strains (p = 0.052). In multivariate analyses, teicoplanin resistance was significant factor for decreased clinical success at TOC (adjusted odds ratio 0.138, 95% confidence interval 0.020–0.961, p = 0.045). Because of the poor clinical efficacy of teicoplanin against teicoplanin-resistant CNS, combination therapy comprising vancomycin and β-lactam antibiotics should be considered in presumed staphylococci BSI.