Effect of augmented renal clearance on plasma concentration of vancomycin and treatment outcome in children with methicillin-resistant Staphylococcus aureus infection / 中国当代儿科杂志

OBJECTIVE@#To investigate the effect of augmented renal clearance (ARC) on plasma concentration of vancomycin, bacteriological outcome, and clinical outcome in children with methicillin-resistant Staphylococcus aureus (MRSA) infection treated by vancomycin.@*METHODS@#A retrospective analysis was performed for the clinical data of 60 critically ill children who were treated with vancomycin due to MRSA infection from January 2013 to July 2017 and underwent plasma concentration monitoring. According to estimated glomerular filtration rate, these children were divided into an ARC group with 19 children and a normal renal function group with 41 children. The two groups were compared in terms of the use of vancomycin, plasma concentration of vancomycin, and treatment outcome.@*RESULTS@#The children in the ARC group had an age of 1-12 years, and the ARC group had significantly higher body weight and body surface area than the normal renal function group (P0.05), but the ARC group had significantly longer length of stay in the pediatric intensive care unit (PICU) and length of hospital stay than the normal renal function group (P<0.05).@*CONCLUSIONS@#ARC can significantly reduce the trough concentration of vancomycin and prolong the length of PICU stay and the length of hospital stay in children with MRSA infection. Idividualized medication should be administered to children with ARC.

Association between vasoactive-inotropic score and prognosis in children with septic shock / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the association between vasoactive-inotropic score (VIS) and prognosis in children with septic shock.</p><p><b>METHODS</b>A total of 117 children with decompensated septic shock who received the treatment with vasoactive agents were enrolled. According to their prognosis, they were divided into death group with 41 children and survival group with 76 children. With the maximum VIS within the first 24 hours (24hVIS max) as the cut-off value (29.5), the children were divided into low VIS group with 78 children and high VIS group with 39 children. The 24hVIS max and the mean VIS within the first 24 hours (24hVIS mean) were calculated for all children. A receiver operating characteristic (ROC) curve analysis was performed for the association between VIS and the prognosis of septic shock.</p><p><b>RESULTS</b>Compared with the survival group, the death group had significantly higher 24hVIS max, 24hVIS mean, PRISM III score, and level of lactate before the use of vasoactive agents and after 24 hours of use (P<0.05). 24hVIS max, 24hVIS mean, PRISM III score, level of lactate before the use of vasoactive agents and after 24 hours of use, and 24-hour pH had a certain value in predicting the prognosis of septic shock, but 24hVIS max had the largest area under the ROC curve. Compared with the low VIS group, the high VIS group had significantly higher number of deaths, PRISM III score, and level of lactate before treatment and after 24 hours of treatment (P<0.05).</p><p><b>CONCLUSIONS</b>VIS is associated with the mortality of children with septic shock, and the severity and mortality of patients increase with the increase in VIS.</p>