80岁以上高龄重症患者使用万古霉素的安全性分析-欢迎访问中华.docVIP

·临床研究（组稿）· 80岁以上高龄重症患者使用万古霉素的安全性分析 黄 敏，周 静，毕立清，韩 艺，张 倩，朱冬梅，周苏明* （南京医科大学第一附属医院老年ICU，南京 210029） 【摘 要】目的 观察万古霉素治疗革兰阳性菌感染的高龄重症患者有效性及其对肾功能的影响。方法 回顾性分析2007年1月至2014年3月期间江苏省人民医院老年ICU收治的≥80岁革兰阳性菌感染的老年患者48例，静脉应用万古霉素，观察患者症状及体征变化，进行病原体分析，评价其临床疗效并动态观察用药期间肾功能变化。结果 48例患者使用万古霉素治疗平均疗程为（18±9）d ，临床有效率为72.92%，其中明确培养或涂片有革兰阳性球菌者39例，共培养出菌株50例，经治疗后细菌清除率为82.25%。万古霉素治疗过程中出现肾毒性12例（25%），单因素logistic回归分析显示，治疗前APACHEⅡ评分（OR＝P＝＝P＝＝P＝＝P＝10.11915/j.issn.1671-5403.2015.xx.xxx Efficacy of vancomycin in elderly patients with severe Gram-positive infections and factors affecting nephrotoxicity HUANG Min, ZHOU Jing, BI Li-Qing, HAN Yi, ZHANG Qian, ZHU Dong-Mei, ZHOU Su-Ming?* (Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China) 【Abstract】 Objective To investigate the efficacy of vancomycin in the treatment of severe Gram-positive infections in elderly patients and to analyze the factors affecting the renal toxicity. Methods A retrospective study was conducted at department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University. From January 2007 to March 2014, elderly patients (age＞80 years) with suspected or actual Gram-positive infection were included if they received 4 or more doses of vancomycin. Data were abstracted from patient charts and pharmacy records. Results There were 48 patients included in the study cohort. The course of vancomycin treatment for the 48 patients was (18?9)d, and the clinical efficiency was 72.92%. Among the 48 patients, 39 cases were found with Gram-positive cocci in the bacterial culture or in smear test. Among them, a total of 50 isolated strains were obtained and the bacterial clearance rate after the vancomycin therapy reached 82.25%. During the vancomycin treatment, 12 cases had renal toxicity, accounting for 25% of the total cases. Univariate and multivariate analyses were used to assess variables predictive of renal toxicity. The univariate analysis showed that the higher APACHE I