万古霉素治疗儿童耐甲氧西林金黄色葡萄球菌骨关节感染血药浓度、24小时药时曲线下面积与临床结局的相关性

目的:研究耐甲氧西林金黄色葡萄球菌(MRSA)骨关节感染患儿的万古霉素谷浓度(C_min)、给药24小时药时曲线下面积(AUC₂₄)与最低抑菌浓度(MIC)比值与临床结局的关系。方法:选取2015年1月至2020年6月在佛山市中医院接受万古霉素治疗的MRSA骨关节感染儿童患者为研究对象,采集患儿基本信息、临床疗效、万古霉素C_min、AUC₂₄以及MIC等数据,分析不同万古霉素血药谷浓度区间、AUC₂₄/MIC区间与临床疗效及不良反应发生率的关系。采用受试者工作特征(ROC)曲线研究C_min、AUC₂₄/MIC与临床疗效的相关性。结果:共30例患儿纳入研究,C_min>10 mg/L组的治愈率(66.67%)与C_min<10 mg/L组(48.15%)比较差异无统计学意义(P>0.05)。AUC₂₄/MIC≥400组的治愈率为81.82%,高于AUC₂₄/MIC<400组的31.58%(P<0.05)。ROC曲线中,C_min的ROC曲线下面积(0.92)较大。万古霉素血药谷浓度分组间的不良反应发生率比较差异无统计学意义(P>0.05)。结论:MRSA骨关节感染儿童患者的万古霉素C_min≥10 mg/L并非是达到最佳疗效的必要条件,但万古霉素谷浓度需维持在5.25 mg/L以上;为保证疗效,有必要使AUC₂₄/MIC≥400。但本研究涉及病例数较少,最佳血药谷浓度范围仍需进一步验证。

Correlation between Blood Concentration, 24-Hour Drug Time Area under the Curve and Clinical Outcome in Children with Orthopedic Infection Induced by Methicillin-Resistant Staphylococcus Aureus

Objective:To study the correlation between trough concentration(C_min)of vancomycin,ratio of 24-hour drug time area under the curve(AUC₂₄)and minimal inhibitory concentration(MIC),and clinical outcome in children with orthopedic infection induced by methicillin-resistant Staphylococcus aureus(MRSA).Methods:Children with orthopedic infection induced by MRSA who received vancomycin in Foshan Hospital of Traditional Chinese Medicine from Jan.2015 to Jun.2020 were selected as the research objects.General information,clinical efficacy,C_minof vancomycin,AUC₂₄and MIC were collected.Correlation between different C_minof vancomycin interval,AUC₂₄/MIC interval and clinical efficacy and incidence of adverse drug reactions was analyzed.Receiver operating characteristic(ROC)curve was used to study the correlation between C_minand AUC₂₄/MIC and clinical efficacy.Results:A total of 30 children were enrolled.There was no significant difference in the cure rate between the C_min>10 mg/L group(66.67%)and the C_min<10 mg/L group(48.15%,P>0.05).The cure rate of AUC₂₄/MIC≥400 group was 81.82%,significantly higher than 31.58%of AUC₂₄/MIC<400 group(P<0.05).In the ROC curve,the area(0.92)under the ROC curve of C_minwas larger.There was no significant difference in the incidence of adverse drug reactions among different C_minof vancomycin groups(P>0.05).Conclusion:C_minof vancomycin≥10 mg/L in children with orthopedic infection induced by MRSA is not necessary for optimal efficacy,yet C_minof vancomycin need to be maintained above 5.25 mg/L.To ensure efficacy,AUC₂₄/MIC≥400 is necessary.However,the sample size in this study is small and the optimal C_minstill needs further validation.