在骨科感染门诊病人的回顾性队列中,从静脉注射万古霉素转为口服抗生素可减少不良事件的发生。

IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pharmacotherapy Pub Date : 2023-12-01 Epub Date: 2023-09-19 DOI:10.1002/phar.2872
Chanah K Gallagher, Heather Cummins, Russell J Benefield, Laura K Certain
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引用次数: 0

摘要

简介:尽管万古霉素的药物不良事件(ADE)发生率较高,但它在治疗骨关节感染时经常被用于延长疗程。本研究旨在评估骨科感染患者过渡到口服治疗与继续使用肠外万古霉素相比的安全性和有效性:我们对骨科感染患者进行了一项单中心回顾性队列研究,患者出院时使用肠外万古霉素,计划疗程至少为 4 周。我们比较了使用万古霉素期间的 ADE 发生率和改用口服方案后的 ADE 发生率。作为辅助分析,我们比较了在开始使用万古霉素 4 周内转为口服抗生素的患者与未转为口服抗生素的患者在 60 天内的非计划再入院率和 1 年后的治疗失败率:228 名患者符合纳入标准。与口服方案相比,万古霉素的毒性明显增加。51名患者在使用万古霉素期间发生了不良事件(每1000个患者日发生5.87起不良事件),而9名患者在口服治疗期间发生了不良事件(每1000个患者日发生1.49起不良事件)(每1000个患者日的不良事件发生率差异为4.39,95% CI:每1000个患者日发生2.52至6.26起不良事件)。在比例危险度分析中,转用口服抗生素方案与较低的 ADE 发生率独立相关(aHR 0.12,95% CI:0.02-0.86)。41名患者(18%)在4周内转为口服治疗;这些患者的非计划再入院率(12.2% vs 17.1%)或治疗失败率(17.1% vs 21.9%)并未增加:结论:与继续使用肠外万古霉素的患者相比,出院后 4 周内转为口服治疗的患者不良事件明显减少,1 年治疗失败的发生率也相似。在治疗骨科感染期间,用口服抗生素替代肠外万古霉素是将万古霉素毒性降至最低的一种潜在策略。
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Switching from intravenous vancomycin to oral antibiotics reduces adverse events in a retrospective cohort of outpatients with orthopedic infections.

Introduction: Vancomycin is frequently used for prolonged courses in treating osteoarticular infections despite a high rate of adverse drug events (ADE). The objective of this study was to evaluate the safety and effectiveness of transitioning to oral therapy compared to continuing parenteral vancomycin in patients with orthopedic infections.

Methods: We conducted a single-center, retrospective cohort study of patients with orthopedic infections discharged on parenteral vancomycin with a planned duration of at least 4 weeks. We compared rates of ADE while on vancomycin to rates of ADE after switching to an oral regimen. As a secondary analysis, we compared unplanned hospital readmission within 60 days and treatment failure at 1 year between patients who were transitioned to oral antibiotics within 4 weeks of vancomycin initiation and those that were not.

Results: Two hundred twenty-eight patients met the inclusion criteria. Vancomycin was associated with significantly greater toxicity compared to oral regimens. Fifty-one patients had an adverse event while on vancomycin (5.87 ADE per 1000 patient-days) while 9 patients had an adverse event on oral therapy (1.49 ADE per 1000 patient-days) (Rate difference 4.39 per 1000 patient days, 95% CI: 2.52 to 6.26 events per 1000 patient-days). In proportional hazards analysis, transition to an oral antibiotic regimen was independently associated with a lower rate of ADE (aHR 0.12, 95% CI: 0.02-0.86). Forty-one patients (18%) were transitioned to oral therapy within 4 weeks; these patients did not have an increased rate of unplanned readmission (12.2% vs 17.1%) or treatment failure (17.1% vs 21.9%).

Conclusions: Patients transitioned to oral therapy within 4 weeks of discharge had significantly fewer adverse events and similar incidences of 1-year treatment failure compared to patients maintained on parenteral vancomycin. Substituting oral antibiotics for parenteral vancomycin is a potential strategy to minimize vancomycin toxicity during the treatment of orthopedic infections.

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来源期刊
Pharmacotherapy
Pharmacotherapy 医学-药学
CiteScore
7.80
自引率
2.40%
发文量
93
审稿时长
4-8 weeks
期刊介绍: Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
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