ABSTRACT
Objective To evaluate the predictive value and to verify the clinical effect of JPKD-vancomycin for the trough concentration of vancomycin in patients with augmented renal clearance (ARC), and to provide a reference for clinical individualized drug therapy. Methods A retrospective analysis was conducted. The clinical data of 48 adult patients with ARC using vancomycin and monitoring steady-state trough concentration of vancomycin admitted to Suzhou Hospital Affiliated to Nanjing Medical University from July 2013 to July 2017 were collected. A combination of classical Vancomycin Calculator software and JPKD-vancomycin software was used. Based on the individual conditions of patients [gender, age, height, weight, serum creatinine (SCr), disease status], Vancomycin Calculator software was used to obtain the recommended regimen and its steady-state trough concentration, and then JPKD-vancomycin software was used to predict the steady-state trough concentration of initial regimen. If the regimen was adjusted during the treatment, JPKD-vancomycin software was used to predict the steady-state trough concentration of the adjusted regimen. The measured values of steady-state trough concentration were recorded. The weight deviation between predicted concentration and measured concentration (WRES) was calculated. WRES < 30% was considered as good prediction, and the predictive value of JPKD-vancomycin software was evaluated for vancomycin trough concentration. Results Forty-eight patients with ARC were enrolled, of whom 24 patients had adjusted the dosing regimen during the treatment. The initial concentration of blood samples was 48, after adjusting the dosage regimen, 24 blood samples were collected. The initial and adjusted daily dose of vancomycin was (2 000±500) mg/d and (2 500±600) mg/d, respectively, and the initial trough concentrations and adjusted trough concentrations was (8.4±7.3) mg/L and (9.1±4.3) mg/L, respectively. Only 14.6% and 25.0% of initial and adjusted trough concentrations reached the target range (10-20 mg/L) without significant difference (P > 0.05). The WRES value of adjusted trough concentrations predicted by JPKD-vancomycin software was significantly lower than that of initial regimen [10.6% (3.0%, 16.4%) vs. 14.3% (10.5%, 38.2%), P < 0.05], and the percentage of WRES < 30% also tended to increase [95.8% (23/24) vs. 70.8% (34/48), P < 0.05]. The well predictive rate of JPKD-vancomycin software for vancomycin trough concentration was 79.2% (57/72), but there were 15 patients with WRES > 30%. Conclusions JPKD-vancomycin software has good predictive value for the vancomycin trough concentration of ARC patients, especially for the trough concentration after adjusting the treatment regimen. JPKD-vancomycin can provide a reference for the design of clinical individualized application of vancomycin.
ABSTRACT
Objective To investigate the role of clinical pharmacist in anti-infection therapy for patients with augmented renal clearance (ARC).Methods A case with multi-site severe infection after traffic accident was treated with anti-infection therapy.According to the characteristics of infection and pharmacokinetics,clinical pharmacist discussed the intervention by clinical pharmacist in terms of formulating anti-infection program and adjustment of individual dose.Results After consultation and evaluation by clinical pharmacist,the patient was diagnosed as ARC.According to pharmacokinetics characteristics reported by literature,vancomycin was adjusted to 1 g (once per 8 h).Based on detection result of pathogenic bacteria,meropenem was replaced by cefoperazone/sulbactam,and the dose was increased to 3 g (once per 6 h).And then,vancomycin concentration was detected again,and it reached ＞ 10 μg· mL-1;pathogenic bacteria culture result was negative.This patient obtained good therapeutic effect.Conclusion Clinical pharmacist could assist physician on anti-infection treatment and dose adjustment of ARC patient,and improve ARC patient's therapeutic effect.
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Objective To analyze the risk factors of type 2 diabetic peripheral neuropathy (DPN),in order to provide incidence for clinical treatment and prevention.Methods Two hundred and eighty-seven patients with type 2 diabetes were divided into DPN group(113 cases) and non-DPN group(174 cases)according to electrophysiological examination and diagnosis.The clinical information were collected including body mass index (BMI),blood pressure,fasting plasma glucose (FPG),2 h postprandial plasma glucose (2 h PG),fasting plasma insulin (FINS),C peptide,glycosylated hemoglobin (HbAl c),blood fat and cholesterin.The DPN prevalence in patients with type 2 diabetes was calculated,and t or x2 analysis and multivariate logistic regression analysis were applied.Results Among the 287 patients with type 2,the DPN prevalence was 39.4％ (113/287).The level of age,duration of diabetes and smoking in DPN group were significantly higher than those of non-DPN group,while exercise,income situation and educational background were significantly lower than those of non-DPN group (x2 =4.378,8.430,4.525,4.500,4.203,6.890,P ＜ 0.05 or ＜ 0.01).Systolic blood pressure((137.52 ± 16.10) mmHg),FPG ((11.42 ± 3.08) mmol/L),2 hPG ((18.70 ± 4.61) mmol/L),HbA1c ((10.21 ± 2.50)％) in DPN group were higher than those of non DPN group ((systolic pressure (132.67± 15.80) mmHg,FPG(9.96 ±3.76) mmol/L,2 hPG(15.38 ±5.26) mmol/L,HbA1c(9.54 ±2.83)％).In DPN group,Fasting insulin,2 h insulin,fasting C peptide were (13.52 ± 4.92) mmol/L,(36.20 ± 17.52) mmol/L,(1.44 ± 0.62) mmol/L,(3.89 ± 3.01) mmol/L,lower than those of non DPN group ((16.76 ± 5.24) mmol/L,(47.95 ± t5.04) mmol/L,(1.83 ± 0.57) mmol/L,(5.24 ± 3.45) mmol/L),and the differences were significant (t =2.512,3.592,5.635,2.105,5.312,5.863,5.372,3.502,P ＜0.05 or P ＜ 0.001).Multiple logistic regression analysis revealed that the level of duration of diabetes,HbA1c,2 hPG were positively correlated with DPN prevalence,and those were the independent risk factors of DPN (OR(95％CI) 1.040(1.018-1.062),1.331(1.032-1.717),1.366(1.044-1.787),P＜0.05).The level of FINS,Fasting C peptide,2 h C peptide were negatively correlated with DPN prevalence,and those were independent protective factors of DPN (OR (95 ％ CI) 0.803 (0.725-0.889),0.923 (0.731-0.954),0.863 (0.801-0.930),P ＜ 0.05).Conclusion The occurrence of DPN is common in patients with type 2 diabetes.The indices of duration of diabetes,HbA1c,2 hPG were risk factors of DPN,and there is more dangerous with the lower level of FINS,Fasting C peptide,2 h C peptide.