Analiza uporabe vankomicina v Splošni bolnišnici Murska Sobota v letu 2018

Vrečič, Urška (author), Kerec - Kos, Mojca (mentor), Kovačič, Alenka (comentor)

Vankomicin je na listi rezervnih protimikrobnih učinkovin, za katera je potrebna izpolnitev Naročilnice za rezervna protimikrobna zdravila s strani zdravnika in nato farmacevta, ki izda zdravila. Ker ima vankomicin ozko terapevtsko okno, tekom zdravljenja spremljamo minimalne koncentracije v krvi, ki morajo biti v območju 7–14 μmol/L. Je protimikrobna učinkovina zadnje izbire, ko je zdravljenje z drugimi učinkovinami neučinkovito zaradi odpornosti nanje, a se zaradi nenadzorovane uporabe že pojavljajo sevi, ki so odporni tudi proti vankomicinu. Nalogo smo izvedli v obliki retrospektivne raziskave. Končni vzorec je obsegal 137 pacientov, ki so se v letu 2018 parenteralno zdravili z vankomicinom v Splošni bolnišnici Murska Sobota. Ocenjevali smo, v kakšni meri zaposleni upoštevajo algoritem za spremljanje zdravljenja z vankomicinom na oddelkih in v lekarni, spremljali indikacije za uporabo vankomicina, ustreznost odmerjanja in čas trajanja zdravljenja, izide zdravljenja in pojav neželenih učinkov (predvsem pojav akutne ledvične odpovedi, ki je eden izmed poglavitnih problemov zdravljenja z vankomicinom), laboratorijske parametre, ki so povezani z vankomicinom oziroma z okužbo ter sočasno predpisana zdravila. Za obdobje 2011–2018 smo izvedli tudi kronološki pregled porabe vankomicina v Splošni bolnišnici Murska Sobota ter izvajanje terapevtskega spremljanja zdravljenja z vankomicinom. Z vankomicinom so najpogosteje zdravili na intenzivnih oddelkih in najpogostejša indikacija za vankomicin je bila sepsa. Pri 52,6 % pacientih je bil začetni odmerek vankomicina 1 g/12 h, v 24,8 % pa 1 g/24 h. Začetno odmerjanje je bilo pravilno glede na ledvično funkcijo pri 86,6 % pacientom, medtem ko začetnega odmerjanja glede na telesno maso nismo zasledili. Le 50,4 % vseh meritev minimalne koncentracije vankomicina v krvi je bilo znotraj terapevtskega območja in 16,8 % pacientov ni niti enkrat tekom zdravljenja doseglo terapevtskega območja. Do akutne ledvične odpovedi je glede na naš kriterij prišlo pri 16 pacientih (11,7 %), ledvična funkcija pa se je skupno poslabšala pri 29,2 % pacientov. Podatki o zdravljenju z vankomicinom v lekarni so se v 27,6 % ujemali z dejanskimi podatki iz popisov. Ocenili smo, da je farmacevt ob izpolnitvi naročilnice ustrezno svetoval v 79,6 % primerov in njegovi nasveti so bili večinoma upoštevani (89,5 %). Poraba vankomicina v Splošni bolnišnici Murska Sobota z leti narašča in sorazmerno temu se viša tudi število pacientov, za katere se izvaja terapevtsko spremljanje zdravljenja. Glede na rezultate predlagamo dodatne možnosti optimizacije zdravljenja z vankomicinom v Splošni bolnišnici Murska Sobota.

• Language: Slovenian
• Keywords: vankomicin, terapevtsko spremljanje koncentracij zdravil, bakterijske okužbe, rezervna protimikrobna zdravila
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2020
• PID: 20.500.12556/RUL-113440
• Publication date in RUL: 07.01.2020

Secondary language

• Language: English
• Title: Analysis of vancomycin use in Murska Sobota General Hospital in 2018

Abstract

Vancomycin is on the list of reserve antimicrobials that require filling an order form for reserved antimicrobials by doctor and then by the pharmacist who dispenses the medicines. Because vancomycin has a narrow therapeutic window, minimal blood levels should be monitored during treatment and should range between 7 and 14 μmol/L. It is the last-resort antimicrobial agent when treatment with other agents is ineffective due to bacterial drug resistance, but vancomycin resistant strains have already emerged due to its uncontrolled use. A retrospective research was performed and the final sample consisted of 137 patients treated parenterally with vancomycin in 2018 at Murska Sobota General Hospital. We evaluated the extent to which employees follow the vancomycin treatment monitoring algorithm in wards and in the hospital pharmacy; we monitored indications for vancomycin use, dose adequacy and duration of treatment; we evaluated treatment outcomes and adverse effects (mainly acute renal failure, which is one of the major problems of vancomycin treatment); we monitored laboratory parameters related to vancomycin or infection and concomitant prescription medications. We also conducted a chronological review of vancomycin use at Murska Sobota General Hospital in 2011–2018 and management of therapeutic monitoring of vancomycin. Vancomycin was the most commonly used in intensive care units and the most common indication for vancomycin was sepsis. In 52,6 % cases, the starting dose of vancomycin was 1 g/12 h and in 24,8 % it was 1 g/24 h. Initial dosing was correct in relation to renal function in 86,6 % of patients, whereas no initial dosing based on body weight was found. Only 50,4 % of all measurements of the minimum vancomycin concentration in the blood were within the therapeutic range and 16,8 % of patients did not reach the therapeutic range even once during treatment. According to our criteria acute renal failure occured in 16 patients (11,7 %) and renal function overall decreased in 29,2 % of patients. Data about treatment with vancomycin in hospital pharmacy were in 27,6 % in accordance with the actual data at wards. From the order form it was estimated that the pharmacist advised correctly in 79,6 % of cases and his advice was mostly accepted (89,5 %). Vancomycin consumption at Murska Sobota General Hospital has been increasing over the years and in proportion to this, the number of patients undergoing therapeutic drug monitoring is increasing. According to these results, we suggest additional options for optimizing vancomycin treatment at Murska Sobota General Hospital.

• Keywords: vancomycin, therapeutic drug monitoring, bacterial infections, reserve antimicrobials