Distribution characteristics of plasma concentration of vancomycin and clinical efficacy in pediatric patients with severe pneumonia and congenital heart disease / 中国小儿急救医学

ABSTRACT

Objective To analyze the distribution characteristics of vancomycin blood concentration in children with severe pneumonia complicated with congenital heart disease( CHD) and children with simple severe pneumonia after using the same dose vancomycin,and observe the clinical efficacy at the same time. Methods Plasma concentrations in pediatric patients with severe pneumonia complicated with CHD ( CHD group) who treated by vancomycin from November 2012 to September 2013 in Shengjing Hospital of China Medical University were collected. Plasma concentrations of children with simple severe pneumonia( control group) treated by vancomycin were also collected at the same period. The blood concentration values and therapeutic effects of the two groups were recorded into the database for statistical analysis. Peak,trough con-centrations and efficacy were analyzed by receiver operating characteristic(ROC) curve. Results Twenty-five children with CHD were collected,the average peak concentration was (28. 39 ± 6. 68) mg/L,the aver-age trough concentration was (13. 34 ± 6. 62)mg/L. Control group were also 25 cases,the average peak con-centration was (16. 23 ± 2. 50) mg/L and the average trough concentration was (2. 77 ± 1. 01) mg/L. Both peak and trough concentrations of CHD children were significantly higher than those of the control group (tpeak =8. 52,Ppeak <0. 05;ttrough =7. 89,Ptrough <0. 05). In the ROC of peak,trough concentrations and effica-cy,area under the curve were 0. 74(95％CI 0. 547-0. 935,P=0. 01) and 0. 77(95％CI 0. 605-0. 935,P=0. 004) respectively,and the difference was statistically significant. Conclusion Plasma concentrations of vancomycin in children with CHD are generally higher,it is necessery to monitor plasma concentration even under regular doses,to make the application of vancomycin more safe and effective in children with CHD. There is a correlation between plasma concentration of vancomycin and clinical efficacy in children,the high-er the blood concentration,the more likely the clinical efficacy is to be effective.