Comparison Of Clinical Efficacy Between Vancomycin And Norvancomycin In Elderly With MRSA Infection And Analysis Of Related Factors Of Occurrence Of Renal Toxicity

Objective: To investigate the clinical efficacy and safety of vancomycin and norvancomycin in the treatment of elderly patients with infection of methicillin-resistant staphylococcus aureus(MRSA)and to analysis of the risk factors related to the occurrence of nephrotoxicity in the treatment of vancomycin and norvancomycin.To provide safety data for clinical use and screening of high risk drugs for elderly patients with reference.Methods: 136 cases of elderly patients hospitalized for MRSA infection from December 2014 to December 2015 was the study object.Part I.All the patients were divided into vancomycin group(n=68)and norvancomycin group(n=68)according to the random list.Vancomycin group was treated with vancomycin for anti-infection treatment,0.5-1.0/g for one time,q12 h,intravenous infusion.Norvancomycin group was treated with norvancomycin for anti-infection treatment,0.8-1.6/g for one time,q12 h,intravenous infusion.The course of the two groups was 10-14 days.The clinical efficacy indexes of clinical symptoms,imaging examination,laboratory examination and bacterial clearance rate were observed and compared in the two groups.The adverse reactions were observed and the safety was evaluated in the two groups.Part II.The complete clinical data of 136 cases of patients were retrospectively analyzed.According to whether patients with nephrotoxicity,the vancomycin group was divided into non-acute renal injury group(NAKI group,n=40)and acute renal injury group(AKI group,n=28),and the norvancomycin group was divided into non-acute renal injury group(NAKI group,n=42)and acute renal injury group(AKI group,n=26).The influencing factors of occurrence of nephrotoxicity including gender,age,site of infection,complications,combined medication,administration time,valley concentration and peak concentration of drug were analyzed.Results:Part I.The comparison results of efficacy and safety of vancomycin group and norvancomycin group(1)There was no significant difference in gender,average age,age distribution,average BMI,department of hospitalization,infection site,average time of hospitalization,complications and combined medications between the vancomycin group and norvancomycin group(P>0.05).(2)The clinical efficacy in two groups was quite similar.The cure rate of clinical symptoms in vancomycin group and norvancomycin group were 85.3% and 86.8%(P=0.805),the bacterial clearance rate were 91.2% and 92.6%(P=0.753),and the rate of clinical efficacy were 79.4% and 82.4%(P=0.663).(3)There was no died in the study.The adverse reactions related with drugs were nephrotoxicity,ototoxicity,phlebitis and rash,and the nephrotoxicity was the mainly one.The incidence of adverse reactions(51.5% and 47.1%)and incidence of nephrotoxicity(41.2% and 38.2%)of vancomycin group and norvancomycin group were similar(P=0.607,0.726).There was no significant difference in the severity of adverse reactions between the two groups(P=0.668).Part II.Analysis results of related factors of nephrotoxicity(1)In the vancomycin group and norvancomycin group,there was no significant correlation between the occurrence of nephrotoxicity and gender,infection site,complications(hypertension,cardiovascular and cerebrovascular diseases,diabetes and immune diseases),combined medication(antibiotics,antihypertensive drugs,hypoglycemic agents,anti angina drugs,anti arrhythmia drugs,dilated blood vessel drugs and regulating blood lipid drugs)and drug peak concentration(P>0.05).(2)In the vancomycin group and norvancomycin group,the related factors of nephrotoxicity were as follow:(1)Gender: The proportion of patients with nephrotoxicity increased with grow older,and it had significant correlation of the occurrence of nephrotoxicity(P=0.004,0.002).(2)Complication: The occurrence of nephrotoxicity was significantly correlated with respiratory failure(type I/II)(P=0.049,0.025)and shock(P=0.048,0.025).(3)Combined medication: The occurrence of nephrotoxicity was significantly correlated with diuretics(P=0.044,0.007).(4)Administration time: The occurrence of nephrotoxicity was significantly correlated with the longer time of administration,and the occurrence of nephrotoxicity was significantly higher in the patients whose time of administration was more than 10 days(P=0.039,0.049).(5)Valley concentration and peak concentration of drug: The occurrence of nephrotoxicity was significantly correlated with the higher valley concentration of drug,and the occurrence of nephrotoxicity was significantly higher in the patients whose valley concentration was more than 20 mg/L(P=0.049,0.044).Conclusion: 1.The vancomycin and norvancomycin can effectively clear the bacteria in the treatment of MRSA infection,and it has the perfectly clinical efficacy.The mainly adverse reaction is nephrotoxicity related with vancomycin and norvancomycin.There is no difference on clinical efficacy and occurrence of adverse reaction and nephrotoxicity between the vancomycin and norvancomycin in treatment of MRSA infection.They are effective,safe,and economical agents for the treatment of MRSA.2.Either vancomycin or norvancomycin in therapy for MRSA,there is no significant correlation between occurrence of nephrotoxicity and sex,site of infection and peak concentration of drug,but it has great correlation with the advanced age,complications of respiratory failure and shock,combined use of diuretics,longer time of administration and higher valley concentration of drug.