Influência dos níveis séricos de vancomicina na resposta clínica do paciente.

Abstract

Vancomycin is a glycopeptide used extensively in infections by Gram positive microorganisms since 1950 for be a efficient and inexpensive antibiotic. However, in recent decades has increased the rates of therapeutic failure due to bacterial resistance and lack of monitoring serum dosage of Vancomycin. Therapeutic serum levels of vancomycin are among 15 μgmL-1 and 20 μgmL-1, dosages in excess of these have been related to nephrotoxicity and lower dosages were related to induction of heteroresistance. The goal of this study was to evaluate the influence of vancomycin serum levels in clinical response of patients admitted to a teaching hospital. We conducted a retrospective cross-sectional study along with Hospital Infection Control Committee (CCIH) Santa Cruz Hospital, located in the municipality of Santa Cruz do Sul, Rio Grande do Sul. Data search occurred in August 2012 period to September 2014. Through the review of medical records, were collected epidemiological data such as gender; age; isolated microorganism; length of stay; Charlson index and outcome. Vancomycin serum levels and creatinine were obtained in the laboratory of clinical analyses of hospital. For the comparison of variables was used the x2 test, Student's t-test and Mann-Whitney test, being considered statistically significant value for p ≤ 0.05. A total of 145 dosages were analyzed from 86 patients with 28.5% of these were newborns, 7.6% children and 63.9% adults. Most of the samples was stemmed from male patients (61.6%) and of 29 patients with confirmed infection, about 50% of the isolates were Staphylococcus coagulase. Only 8.6 percent of the dosages were among the therapeutic window, 51.4% were below the 40% above specified. Of the patients, 25.7% were to death and has not been verified against this with Vancomycin serum levels (p = 0.892). The length of stay has not been affected by the serum levels 10 μgmL-1 (p = 0.401) and 15 μgmL-1 (p = 0.152) of antimicrobial. Vancomycin levels greater than 20 μgmL-1 (p = 0.003) and 15 μgmL-1 (p = 0.001) were related to kidney damage. Higher levels were observed for adults (23.42 μ gmL -1) compared with newborns (15.06 μgmL-1) and children (14.06 μgmL-1) (p = 0.044 and p < 0.001). The nephrotoxicity was related to serum levels of vancomycin higher 15 μgmL -1. Were observed serum levels more appropriate for infants and children when compared to adults, so suggesting a need of using pharmacokinetic calculations for drug prescription to adults. Empirical dosage can result in serum levels outside the range established therapy, compromising the effectiveness of the treatment.