医学
万古霉素
药代动力学
重症监护医学
急诊医学
小儿烧伤
外科
内科学
生物
细菌
遗传学
金黄色葡萄球菌
作者
Catherine M.T. Sherwin,Nam K. Tran,Kathleen Sullivan,Stephanie Wead,Angela K. Birnbaum,Charul Avachat,Daniel P. Healy,Richard J. Kagan
出处
期刊:Journal of Burn Care & Research
[Oxford University Press]
日期:2022-10-04
卷期号:44 (2): 353-362
摘要
Abstract Sepsis remains one of the leading causes of death among pediatric patients with burn injuries. Despite limited vancomycin pharmacokinetic (PK) information within this population, it is widely used to treat severe burn injuries. Those with severe burns are at risk of nephrotoxicity, with an incidence of acute kidney injury (AKI) over 50%. Delivering an effective vancomycin dose and avoiding unnecessary toxicity is essential for improved patient outcomes. This was a retrospective analysis of 115 children aged 0.2 months to 18 years with severe burns, >10% total body surface area. Vancomycin was given via intravenous infusion; blood samples were drawn between 6- and 12-hour postinfusion. A population pharmacokinetic model was developed using nonlinear mixed-effect modeling (Monolix, version 2016R1). A one-compartment model described a steady-state volume of distribution (V), dependent on weight. Vancomycin clearance (CL) was influenced by age and estimated creatinine clearance (CrCL). The study population’s (median age = 4 years, median weight = 20 kg, median total body surface area (%TBSA) = 40%) median V and CL were calculated to be 1.25 L/kg (95% CI, 1.04–1.46) and 0.15 L/h/kg (95% CI, 0.126–0.165), respectively. The PK model was explicitly developed to characterize the impact of physiological changes in children under 18 years of age and the percentage of the burn surface area using limited data. The analysis determined that weight, age, and estimated CrCL were important covariates in predicting vancomycin PK with high variability in CL and V.
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