Treatment of postoperative central nervous system infection with vancomycin：a retrospective survey about the dose
10.3760/cma.j.issn.2095-4352.2016.07.011
- VernacularTitle:万古霉素治疗神经外科术后中枢神经系统 感染：一项针对处方剂量的回顾性调查
- Author:
Jingjing HAO
;
Zhonghua SHI
;
Han CHEN
;
Yu WANG
;
Yumei WANG
;
Ming XU
;
Jianxin ZHOU
- Publication Type:Journal Article
- Keywords:
Vancomycin;
Central nervous system infection;
Neurosurgery;
Clinical dosing
- From:
Chinese Critical Care Medicine
2016;28(7):629-633
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the dose of vancomycin for the treatment of central nervous system (CNS) infection after neurosurgery. Methods The information of hospitalized patients treated by vancomycin after neurosurgery from January 2011 to December 2015 at Beijing Tiantan Hospital, Capital Medical University was collected retrospectively. The patients with CNS infection were retrieved, the relevant data were extracted and systemized. A daily dose of 2 g or 30-60 mg/kg of vancomycin was thought as the standard, and the difference between the actual dose and the guidelines was analyzed. Results There were 5 816 patients used vancomycin for a total of 46 787 days. The number of patients with CNS infection after neurosurgery was 1 198 (20.6%), the total treatment course was 14 083 days (30.1%), the median treatment days was 9, the median daily dose was 26.0 mg/kg; and the percentage of male patient was 50.8%, the median age was 42.0 years, and the median body weight was 68.0 kg. The most commonly used dose and frequency of vancomycin was 1.0 g every 12 hours with 6 957 days (49.4%) and 60.3% daily dose of vancomycin reached the standard. 355 patients were treated to the target and 843 patients were treated empirically, the age of targeted treatment group was older than empirical treatment group [years: 44.0 (32.5, 54.0) vs. 41.0 (31.0, 52.0), P < 0.05]. The mean duration of targeted treatment group was obviously longer than empirical treatment group [days: 11 (6, 17) vs. 9 (6, 12), P < 0.01], but there was no difference in the total daily dose between the two groups [mg/kg: 25.4 (20.0, 30.3) vs. 26.1 (20.9, 31.0), g: 1.80 (1.50, 2.00) vs. 1.85 (1.50, 2.00), both P > 0.05], and daily dose of both groups did not reached the standard goal. 16.3% patients (195/1 198) received multi-courses therapy and there was no difference among the first course of dose. The clinical mortality of all patients was 1.5% (18/1 198). The targeted treatment and multi-courses had a higher proportion in the death group, and the treatment durations were longer than the non-death group [the targeted treatment proportion: 72.2% (13/18) vs. 29.0% (342/1 180), the multi-courses proportion: 83.3% (15/18) vs. 15.3% (180/1 180), the total treatment duration: 29.0 (17.8, 45.0) vs. 9.0 (6.0, 14.0), the days of the first course: 11.5 (7.5, 21.5) vs. 8.0 (6.0, 12.0), all P < 0.05]. Conclusions The dose of vancomycin to treat postoperative CNS infection was inappropriate in a majority of patients. Clinician's education regarding appropriate vancomycin dosing is recommended to achieve compliance with the guidelines.
