Newborns with staphylococcus aureus and coagulase-negative sepsis treated with vancomycin after an increase in serum levels around the valley

Autores

  • Rosane Okasaki Estudante de graduação. Programa de Iniciação Científica. Faculdade de Medicina da Universidade de São Paulo.
  • Werther Brunow de Carvalho Professor Titular Terapia Intensiva - Neonatologia do Instituto da Criança - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Graduado em Medicina, Faculdade de Ciências Médicas de Santos (1977), Título de Especialista em Terapia Intensiva e Neonatologia, em Nutrição Parenteral e Enteral. Atualmente é Chefe da UTI Hospital Santa Catarina.
  • Maria Esther Jurfest Rivero Ceccon Livre Docente. Chefe da UTI neonatal do Instituto da Criança. Coordenadora de Ensino da Disciplina de Neonatologia e de Pesquisa da UTI Neonatal

DOI:

https://doi.org/10.7322/jhgd.143846

Palavras-chave:

Vancomycin, intensive care units, neonatal, newborn, staphylococcus aureus

Resumo

Introduction: Vancomycin is a glycopeptide antibiotic considered the gold standard in the treatment of staphylococcal infections that are oxacillin-resistant.

Objective: To analyse the concentration of serum level in the voucher (one hour before the next administration of the drug dose) of vancomycin in newborns with Staphylococcus aureus infection or oxacillin-resistant coagulase-negative.

Methods: This is an experimental study with data collection between the years 2001 and 2016. We selected 30 patients who had staphylococcus aureus and coagulase-negative sepsis and used vancomycin as a treatment. We collected and recorded their serum levels.

Results: Of the 30 patients included in the present study, 80% were preterm. Among all the newborns, mean serum concentrations in the vancomycin valley were 40% adequate, 13.34% lower than expected, and 46.67% higher than the reference values. In seven patients (23.34%), the first serum level in the Vancomycin valley collected was adequate, but in nine (30%) and 14 (46.67%) patients, the serum concentration in the valley was respectively below and above the correct values. After dose shifting of those who did not achieve adequate levels, only three of the 14 patients in whom the first dose was not adequate had a mean serum total level within the expected range; the remaining 11 stayed at high levels, which raised great concern due to the fact that if the infection is not being treated, the elevated serum level leads to nephrotoxic and ototoxic problems. The monitoring of serum levels in the vancomycin valley is of great importance as it minimises nephrotoxic effects, thus increasing the efficacy of the drug. The dosage adjustment of vancomycin in severely ill patients admitted to an intensive care unit is important and requires more studies related to this area, as the work of a multidisciplinary body makes the treatment better and more specific.

Conclusion: The concentrations of serum levels in the Vancomycin valley (10–15 μg/mL) in patients hospitalised in a neonatal intensive care unit of a reference hospital in Latin America were thought to be bactericidal; however, this is not the values observed in our study.


Downloads

Os dados de download ainda não estão disponíveis.

Biografia do Autor

  • Werther Brunow de Carvalho, Professor Titular Terapia Intensiva - Neonatologia do Instituto da Criança - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Graduado em Medicina, Faculdade de Ciências Médicas de Santos (1977), Título de Especialista em Terapia Intensiva e Neonatologia, em Nutrição Parenteral e Enteral. Atualmente é Chefe da UTI Hospital Santa Catarina.

     

     

Referências

Janssen EJH, Välitalo PA, Allegaert K, Simons SH, Sherwin CM, Mounton JW, et al. Towards rational dosing algorithms for vancomycin in neonates and infants based on population pharmacokinetic modeling. Ant Agen And Che. 2015;60(2):1013-21. DOI: http://dx.doi.org/10.1128/aac.01968-15

Wilhelm MP, Estes L. Vancomycin. Mayo Clinic Proced. 1990 Sep; 74 (9):928-935.

Goodman A, Gilman A. As bases farmacológicas da terapêutica. 10th ed. Rio de Janeiro: Guanabara Koogan; 2003.

Jean-Baptiste N, Benjamin DK Jr, Cohen-Wolkowiez M, Fowler VG Jr, Laughon M, Clark RH, et al. Coagulase-negative staphylococcal infections in the neonatal intensive care unit. Infect Control Hosp Epidemiol. 2011;32(7):679-86. DOI: http://dx.doi.org/10.1086/660361

Cunha MLRS, Lopes CAM, Rugolo LMSS, Chalita LVAS. Significância clínica de estafilococos coagulase-negativa isolados de recém-nascidos. J Ped. 2002;78(4):279-88. DOI: http://dx.doi.org/10.1590/s0021-75572002000400006

Rybak MJ, Lomaestro BM, Rotschafer JC, Moellering RC, Craig WA, Billeter M, et al. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases society of america, the american society of health‐system pharmacists, and the society of infectious diseases pharmacists. Clin Infect Dis. 2009; 49(3):325-7. DOI: http://dx.doi.org/10.1086/600877

Reis AGAC, Grisi SJFE. Monitorização das concentrações séricas da vancomicina em crianças com infecções por bactérias multirresistentes. J Ped. 1996;72(4):225-9. DOI: http://dx.doi.org/10.2223/jped.617

Yasuhara M, Iga T, Zenda H, Okumura K, Oguma T, Yano Y, et al. Population pharmacokinetics of vancomycin in japanese adult patients. Ther Drug Monit. 1998;20 (2):139-48. DOI: http://dx.doi.org/10.1097/00007691-199804000-00003

Fernandez E, Perez R, Hernandez A, Tejada P, Arteta M, Ramos JT. Factors and mechanisms for pharmacokinetic differences between pediatric population and adults. Pharmaceutics. 2011;3(1):53-72. DOI: http://dx.doi.org/10.3390/pharmaceutics3010053

Machado JKK, Feferbaum R, Diniz EMA, Okay TS, Ceccon MEJ, Vaz FAC. Monitoração terapêutica com vancomicina em recém-nascidos de termo com sepse: utilização e importância clínica. Rev Hosp Clínicas. 2001;56(1):17-24. DOI: http://dx.doi.org/10.1590/S0041-87812001000100004

Ringenberg T, Robinson C, Meyers R, Degnan L, Shah P, Siu A, et al. Achievement of therapeutic vancomycin trough serum concentrations with empiric dosing in neonatal intensive care unit patients. Pediatr Infect Dis J. 2015;34(7):742-7. DOI: http://dx.doi.org/10.1097/inf.0000000000000664

Elyasi S, Khalili H. Vancomycin dosing nomograms targeting high serum trough levels in different populations: pros and cons. Eur J Clin Pharmacol. 2016;72(7):777-88. DOI: http://dx.doi.org/10.1007/s00228-016-2063-8

Allegaert K, Verbesselt R, Naulaers G, Van den Anker JN, Rayyan M, Debeer A, et al. Developmental pharmacology: neonates are not just small adults. Acta Clin Belg. 2008;63(1):16-24. DOI: http://dx.doi.org/10.1179/acb.2008.003

Alves MLP, Melo GAN, Yamada SS, Nishiyama P. Therapeutic monitoring of vancomycin. Acta Sci Health Sci. 2012;34(2):199-204. DOI: http://dx.doi.org/10.4025/actascihealthsci.v34i2.10617

Almeida R, Barros EJG, Thomé FS. Vancomicina: Avaliação do uso em pacientes internados na Unidade de Terapia Intensiva. Disertação (Mestrado) - Universidade Federal do Rio Grande do Sul. Porto Alegre: 2011.

Dellit TH, Owens RC, McGowan Jr JE, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159-77. DOI: http://dx.doi.org/10.1086/510393

Tzialla C, Borghesi A, Serra G, Stronati M, Corsello G. Antimicrobial therapy in neonatal intensive care unit. Ital J Pediatr. 2015; 2015;41:27. DOI: http://dx.doi.org/10.1186/s13052-015-0117-7

Sánchez PJ, Moallem M, Cantey JB, Milton A, Michelow IC. Empiric therapy with vancomycin in the neonatal intensive care unit: let's “get smart” globally!. Ped J. 2016; 92(5):432-5. DOI: http://dx.doi.org/10.1016/j.jped.2016.06.001

Lewis K. Platforms for antibiotic discovery. Nat Rev Drug Discov. 2013;12(5):371-87. DOI: http://dx.doi.org/10.1038/nrd3975

Okano A, Isley NA, Boger DL. Peripheral modifications of [Ψ[CH2 NH]Tpg 4]vancomycin with added synergistic mechanisms of action provide durable and potent antibiotics. Proc Natl Acad Sci U S A. 2017;114(26):E5052-61. DOI: http://dx.doi.org/10.1073/pnas.1704125114

Downloads

Publicado

2018-03-12

Edição

v. 28 n. 1 (2018)

Seção

Artigos Originais

Licença

CODE OF CONDUCT FOR JOURNAL  PUBLISHERS

 

Publishers who are Committee on Publication Ethics members and who support COPE membership for journal editors should:

 

Publishers should:

 

  • Define the relationship between publisher, editor and other parties in a contract
  • Respect privacy (for example, for research participants, for authors, for peer reviewers)
  • Protect intellectual property and copyright
  • Foster editorial independence

 

Publishers should work with journal editors to:

 

  • Set journal policies appropriately and aim to meet those policies, particularly with respect to:

–         Editorial  independence

–         Research ethics, including confidentiality, consent, and the special requirements for human and animal research

–         Authorship

–         Transparency and integrity (for example, conflicts of interest, research funding, reporting standards

–         Peer review and the role of the editorial team beyond that of the journal editor

–         Appeals and complaints

  • Communicate journal policies (for example, to authors, readers, peer reviewers)
  • Review journal policies periodically, particularly with respect to new recommendations from the COPE
  • Code of Conduct for Editors and the COPE Best Practice Guidelines
  • Maintain the integrity of the academic record
  • Assist the parties (for example, institutions, grant funders, governing bodies) responsible for the investigation of suspected research and publication misconduct and, where possible, facilitate in the resolution of these cases
  • Publish corrections, clarifications, and retractions
  • Publish content on a timely basis