Study On Individualized Pharmaceutical Care For Critically Ill Patients Treated With Vancomycin Based On TDM

Critically ill patients are often accompanied by serious infection,receive invasive operations such as indwelling catheter and tracheotomy.High incidence of acquiring methicillin-resistant Staphylococcus aureus（MRSA）in intensive care unit.With the production of multidrug-resistant bacteria,vancomycin is more and more widely used in critically ill patients.Vancomycin is a glycopeptide antibiotic,mainly used to treat gram-positive infection,especially MRSA.Because of its narrow treatment window,large individual differences in people,and strong toxic reaction,individualized treatment of Vancomycin is particularly important.Critically ill patients often with Systemic inflammatory response syndrome,hemodynamic instability,surgery and trauma,reduced perfusion of the kidney,results acute kidney injury（AKI）.Critically ill patients is a high-risk group of AKI.Vancomycin can cause nephrotoxicity,critically ill patients using vancomycin will increase the risk of AKI.Therefore,there is an urgent need for prevention of AKIFirstly,the data of patients using who used vancomycin from January 2019 to December 2020 was collected,and retrospective analyzed the current situation of vancomycin clinical application in critically ill patients.A total of 156 cases were collected,commonly used by intensive care unit（23.72%）,the rate of TDM was 5.4%.The proportion of irrational drug use situation is 49.35%.Due to the pathophysiological characteristics in critically ill patients,TDM needs to be carried out comprehensively in order to ensure the effectiveness and safety of drug use.To carry out TDM,establish a method of determining the concentration of vancomycin in human plasma by UPLC.employed a C₁₈column as an analytical column,and methanol-0.05 mol/L potassium dihydrogen phosphate as mobile phase,with column temperature 40℃,flow rate 0.4m L/min,and detection wavelength set at267 nm.The retention time of vancomycin is 7.807 min,and the retention time of internal standard was 6.284 min,vancomycin and internal standard peak were separated completely,both peak shape is complete with no interference of spurious peaks.The linearity of vancomycin serum concentration was good in the range of2.5～80μg/ml.The regression equation is:y=0.0504x+0.0019,R2=0.999.recovery rate is between 90%～100%,both intra-day precision and inter-day precision RSD<5%,at room-temperature within 48 hours,freeze-thaw 3 times and long-term storage at-20℃ precision RSD<8%.The UPLC method established in this study for the determination of vancomycin serum trough concentration in critical ill patients is accurate,precise.The method is proved to meet requirements of biological sample analyses,its suitable for clinical use.In this study,using the risk prediction flowchart of vancomycin-induced acute kidney injury,distinguish high,medium and low risk groups,early intervention to prevent acute kidney injury.And using“JPKD”software based on population pharmacokinetics combine with Bayesian analysis method,to dosing adjustments,provides the help for clinical medication,optimize the pharmaceutical care of vancomycin individualized treatment mode.Compare the control and test groups,the effectiveness and safety is statistically significant.The economy indicators of two groups is no statistically different.The efficacy and safety of test group better than control group.In conclusion,in this study,we using the risk prediction flowchart with TDM,optimize the pharmaceutical care of vancomycin individualized treatment mode,the model of pharmaceutical care of vancomycin designed by this study is improve clinical effectiveness and safety.