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Đã xuất bản: 2022-06-11
Số lượt xem tóm tắt: 136
Số lượt xem PDF: 143
DOI: https://doi.org/10.52852/tcncyh.v154i6.873
Số xuất bản
Tập 154 Số 6 (2022): Tập 154 số 6 E10
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Huong, T. T. ., Hoc, T. H., Cuong, N. C., & Son, T. Q. (2022). 20. Clinical features, microbiology, and vancomycin regimens in sepsis patients: A retrospective study conducted at a single infectious diseases center. Tạp Chí Nghiên cứu Y học, 154(6), 161-168. https://doi.org/10.52852/tcncyh.v154i6.873

20. Clinical features, microbiology, and vancomycin regimens in sepsis patients: A retrospective study conducted at a single infectious diseases center

Tran Thu Huong, Tran Hieu Hoc, Ngo Chi Cuong, Tran Que Son

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Tóm tắt

Despite increasing antibiotic resistance, vancomycin remains the first choice to treat severe infections due to drug-resistant gram-positive bacteria. This study aimed to summarise the clinical, microbiological, and vancomycin treatment outcomes in bacteremia patients. From July to December 2019, a retrospective cohort analysis was conducted on patients with bacteremia treated with vancomycin at a tertiary hospital in Hanoi, Vietnam. Patients without vancomycin concentrations were excluded from the study. Patients had a median age of 54 years (IQR, 41.8 - 63.3), with a male/female ratio of 1.86. Renal complication was markedly different; Clcr < 60, 60 - 130, and > 130 mL/min was 29%, 60%, and 11%, respectively. The median Charlson score was 3.0 (2-4.3), the qSOFA score was 1 (1-2), and the NEWS score was 76%, with a median of 6 (5-8). Twenty-one cases had positive blood culture where85.7% were gram-positive. 93% of patients with sepsis were treated with vancomycin as the first antimicrobial, of which 72% used vancomycin in combination with other antibiotics. Renal complications occurred in 12% of all patients, with grades R, I, and F accounting for 4%, 5%, and 3%, respectively. The median duration of treatment was 12 days (IQR, 7-17), with a success rate of 82 % and a failure rate of 18%, respectively.


Conclusions: In most patients with bacteremia, microbiological tests reveal no detectable bacteria. When sepsis is suspected, a vancomycin regimen should be initiated.

Chi tiết bài viết

Từ khóa

Vancomycin, Treatment Outcome, Bacteremia, Anti-Bacterial Agents, AUC/MIC

Tài liệu tham khảo

1. Kovach CP, Fletcher GS, Rudd KE, Grant RM, Carlbom DJ. Comparative prognostic accuracy of sepsis scores for hospital mortality in adults with suspected infection in non-ICU and ICU at an academic, public hospital. PLoS One. 2019; 14(9): e0222563.
2. Rieg S, Peyerl-Hoffmann G, de With K, Theilacker C, Wagner D, Hubner J, et al. Mortality of Staphylococcus aureus bacteremia and infectious diseases specialist consultation--a study of 521 patients in Germany. J Infect. 2009; 59(4): 232-9.
3. Diekema DJ, Hsueh PR, Mendes RE, Pfaller MA, Rolston KV, Sader HS, et al. The Microbiology of Bloodstream Infection: 20-Year Trends from the SENTRY Antimicrobial Surveillance Program. Antimicrob Agents Chemother. 2019; 63(7): 1-10.
4. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the Infectious Diseases Society of America for treating methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011; 52(3): e18-55.
5. Rybak MJ, Le J, Lodise TP, Levine DP, Bradley JS, Liu C, et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2020; 7: 335-864.
6. Chong YP, Moon SM, Bang KM, Park HJ, Park SY, Kim MN, et al. Treatment duration for uncomplicated Staphylococcus aureus bacteremia to prevent relapse: analysis of a prospective observational cohort study. Antimicrob Agents Chemother. 2013; 57(3): 1150-6.
7. Matsumoto K, Takesue Y, Ohmagari N, Mochizuki T, Mikamo H, Seki M, et al. Practice guidelines for therapeutic drug monitoring of vancomycin: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. J Infect Chemother. 2013; 19(3): 365-80.
8. Takeshita N, Anh NQ, Phuong DM, Thanh DV, Thuy PP, Huong MTL, et al. Assessment of Bacteremia in a Large Tertiary Care Hospital in Northern Vietnam: a Single-Center Retrospective Surveillance Study. Jpn J Infect Dis. 2019; 72(2): 118-20.
9. Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G, et al. STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int J Surg. 2019; 72: 156-65.
10. Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Med. 2019; 7: 2050312119835043.
11. Charlson M, Szatrowski TP, Peterson J, Gold JJJoce. Validation of a combined comorbidity index. Journal of clinical epidemiology. 1994; 47(11): 1245-51.
12. Goulden R, Hoyle M-C, Monis J, Railton D, Riley V, Martin P, et al. qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis. Emergency Medicine Journal. 2018; 35(6): 345-9.
13. Centers for Disease Control Prevention Atlanta. National Healthcare Safety Network (NHSN) patient safety component manual 2017 [Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf.
14. Cockcroft DW, Gault HN. Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16(1): 31-41.
15. Bệnh viện Bạch Mai. Hướng dẫn sử dụng và giám sát điều trị vancomycin trên bệnh nhân người lớn. Quyết định số 84/QĐ-BM ngày 04/01/20192019.
16. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky PJCc. Acute renal failure–definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Springer Link. 2004; 8(4): R204.
17. Clinical and Laboratory Standards Institute. Performance standards for Antimicrobial Sucepcibility Testing, M100, 29th edition. 2019: 1-25.
18. Seah J, Lye DC, Ng TM, Krishnan P, Choudhury S, Teng CB. Vancomycin monotherapy vs. combination therapy for the treatment of persistent methicillin-resistant Staphylococcus aureus bacteremia. Virulence. 2013; 4(8): 734-9.
19. Chaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M, et al. Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). Enferm Infecc Microbiol Clin. 2018; 36(2): 112-9.
20. Schweizer ML, Furuno JP, Harris AD, Johnson JK, Shardell MD, McGregor JC, et al. Comparative effectiveness of nafcillin or cefazolin versus vancomycin in methicillin-susceptible Staphylococcus aureus bacteremia. BMC infectious diseases. 2011; 11: 279.
21. Nguyễn Trường Sơn và các cộng sự. Khảo sát tình hình tổn thương thận cấp ở bệnh nhân điều trị tại khoa Hồi sức, Bệnh viện Chợ Rẫy. Tạp chí Y học Thành phố Hồ Chí Minh. 2017; 21(3): 1-7.