Keywords
Neurosurgery
Multiple trauma
Intensive care unit
Antibacterials
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Abstract
Objective: To describe the characteristics of vancomycin use, dosage and clinical indicators in critically ill neurosurgical and polytraumatized patients. Methods: A prospective, uncontrolled cross-sectional study with a quantitative approach, carried out between February and July 2021. Thirty-six patients were included. The collection instrument addressed sociodemographic variables, characterization of drug use and clinical indicators. The analysis of variables was performed using descriptive statistics, preceded by a test to verify the normality of the data. Results: There was an occurrence of poor antimicrobial assistance in general, given the short period of time to start the drug, lack of cultures to justify its prescription, empirical antimicrobial application and frequent subtherapeutic levels of the drug. A variability in serum vancomycin values is also observed, especially as a function of Ceatinine (CR) and Glomerular Filtration Rate (GFR) clearance. Conclusion: The established therapeutic insecurity focuses on the need for pharmacotherapeutic parameterization and infectious surveillance, considering the criticality of the profile of patients in the study.
References
BAKKE V, et al. Vancomycin levels are frequently subtherapeutic in critically ill patients: a prospective observational study. Acta Anaesthesiol Scand, 2017; 61(6):627-635.
CARDOSO FRG, et al. Profile of patients presenting hospital-acquired infection at intensive care units of public hospitals. Rev Epidemiol Controle Infecç, 2021; 10(4):1-7.
CARLOS ALNS, et al. Incidência de infecções de sítio cirúrgico em neurocirurgias em pacientes oncológicos. Revista Eletrônica Acervo Saúde, 2020; 12(10): e3966.
FONSECA GS, et al. Desempenho das equações baseadas em creatinina para estimativa da taxa de filtração glomerular comparadas à depuração da creatinina endógena. Braz. J. Nephrol, 2021.
GUO T, et al. External evaluation of population pharmacokinetic models of vancomycin in large cohorts of intensive care unit patients. Antimicrob Agents Chemother, 2019; 63: e02543-18.
HESPANHOL LAB, et al. Infecção relacionada à Assistência à Saúde em Unidade de Terapia Intensiva Adulto. Enferm Glob, 2019; 53(1): 229-241.
KISAT M, ZARZAUR B. Antibiotic Therapy in the Intensive Care Unit. Surgical Clinics of North America, 2022; 102: 159-167,
KUREBAYASHI L, et al. Clinical evaluation of patients with Vancomycin spacer retained for more than 12 months. Acta Ortop Bras, 2019; 27(1): 55-8.
LIU C, et al. Diretrizes Práticas da Infectious Diseases Society of America para o Tratamento de Infecções por Staphylococcus aureus Resistente à Meticilina em Adultos e Crianças. Infectious Diseases Society of America, 2011; e18-e55.
MALTA DC, et al. Avaliação da função renal na população adulta brasileira, segundo critérios laboratoriais da Pesquisa Nacional de Saúde. Rev Bras Epidemiol, 2019; 22(suppl 02): e190010.
MOTA FS, et al. Perfil e prevalência de resistência aos antimicrobianos de bactérias Gram-negativas isoladas de pacientes de uma unidade de terapia intensiva. RBAC, 2018; 50(3): 270-7.
NASCIMENTO S, et al. Perfil epidemiológico de pacientes adultos com traumatismo cranioencefálico grave na rede SUS do Distrito Federal: um estudo retrospectivo. Rev Bras Neurol, 2020; 56(4): 5-10.
OBARA VY, et al. Esquema posológico atualmente utilizado para vancomicina falha em obter níveis terapêuticos em 40% dos pacientes internados em unidade de terapia intensiva. Rev Bras Ter Intensiva, 2016; 28(4): 380-386.
QIAN X, et al. Evaluation on variability and safety of serum trough concentrations of vancomycin in patients admitted to intensive care unit. Int J Infect Dis, 2017; 60: 17-22.
RYBAK MJ, et al. Executive Summary: Therapeutic Monitoring of Vancomycin for Serious Methicillin-Resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review of the American Society of Health System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Journal of the Pediatric Infectious Diseases Society, 2020; 9: 281-284.
TAFELSKI S, et al. Observational clinical study on the effects of different dosing regimens on vancomycin target levels in critically ill patients: Continuous versus intermittent application. J Infect Public Health, 2015; (4): 355-63.
TAUFFER J, et al. Caracterização das infecções de sítio cirúrgico em pacientes submetidos à neurocirurgia em um hospital público entre 2017 a 2019. Vigil sanit debate, 2021; 9(2): 104-110.
TIAN L, et al. Direct detection of antibiotic resistance in chinese helicobacter pylori clinical isolates by sequencing-based approach. Journal of Healthcare Engineering, 2022; 6436256.
VINCENT JL, et al. The SOFA (Sepsis.related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med, 1996; 22(7): 707-10.
WU FLL, et al. A Larger Dose of Vancomycin Is Required in Adult Neurosurgical Intensive Care Unit Patients Due to Augmented Clearance. Ther Drug Monit, 2015; 37(5): 609-618.
ZAHA DC, et al. Recent Advances in Investigation, Prevention, and Management of Healthcare-Associated Infections (HAIs): Resistant Multidrug Strain Colonization and Its Risk Factors in an Intensive Care Unit of a University Hospital. BioMed Res Int, 2019; 2510875: 1-9.