Therapeutic Monitoring of Vancomycin in Critical Ill Patients: a Registry (VCMTDMinCI)
연구 개요
상세 설명
Vancomycin is a glycopeptide antibiotic that is the first line antibiotics for the treatment of serious gram-positive infections involving methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin use is associated with several adverse events, including nephrotoxicity and ototoxicity. Its therapeutic window is narrow, so there is a need to monitor serum vancomycin concentration in clinical practice, especially in the critically ill patients. Moreover, the Chinese vancomycin TDM guideline recommended that vancomycin dosage should be administered and adjusted individually based on population pharmacokinetic(PPK) and Bayesian methods. However, there is a gap between clinical practice and the guideline. So far, few studies have investigated the clinical outcomes of the dosage strategy that vancomycin dosage is administered and adjusted individually using PPK and Bayesian methods. Pharmacists could provide the vancomycin individualized dosing service by joining the ICU multidisciplinary team. The objective of this study is to investigate the effectiveness, safety and economics of the vancomycin individualized dosing service provided by pharmacists.
This is a single-center, ambispective cohort study. Patients from the retrospective and prospective cohort will be divided into 2 groups by exposure. The exposure is whether patients received pharmacists' consultation. Patients who meet the inclusion and exclusion criteria will be included in our registry. As a non-intervention study, these information as below will be collected: basic demographics, diagnosis, the initial dosage regimen and adjusted strategy of vancomycin, combined special treatment and outcomes.
연구 유형
등록 (예상)
연락처 및 위치
연구 장소
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Beijing
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Beijing, Beijing, 중국, 100191
- 모병
- Peking University Third Hospital
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연락하다:
- Qinggang Ge, M.D.
- 이메일: qingganggelin@126.com
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연락하다:
- Yingying Yan, Ph.D.
- 이메일: yanyingying89@163.com
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참여기준
자격 기준
공부할 수 있는 나이
- 어린이
- 성인
- 고령자
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
샘플링 방법
연구 인구
The prospective cohort: all patients in this cohort will receive pharmacist consultation when prescribed vancomycin.
The retrospective cohort: patients in this cohort received usual care from JAN 2010 to MAR 2015; patients in this cohort received pharmacist consultation from APR 2016 to JUL 2016.
설명
Inclusion Criteria:
- Admitted to intensive care unit(ICU), Peking University Third Hospital since JAN 2010.
- Receiving vancomycin therapy for 72 hours or more.
- Aged ≥ 18 years.
Exclusion Criteria:
- Administration of vancomycin in non-intravenous access.
- Life expectancy of less than 24 hours.
- Pregnancy women.
- Presence of immunodeficiency.
- Presence of hematological disorder.
- Written informed consent not obtained in the prospective cohort.
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
코호트 및 개입
그룹/코호트 |
개입 / 치료 |
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Pharmacist consulting group
When physicians make the decision that patients need to prescribe vancomycin or need dose adjustment, they will call for a pharmacist consultation.
Pharmacists will provide the initial regimen based on PPK methods if applicable, otherwise give the suggestion of the initial dosage according to guidelines.
Also, pharmacists will give suggestions on the time of sampling for serum concentration measurement.
For dosage adjustment, pharmacists will be informed the results of serum vancomycin concentration, and then make a calculation using Bayesian estimation to determine whether there is a necessity to change the dosing regimen.
Pharmacists will follow the patients until they discharge.
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Pharmacists consultation of vancomycin individualized dosing strategy
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Usual care group
Empirical use of vancomycin without pharmacists consultation.
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
기간 |
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The rate of treatment failure
기간: 2016-9 to 2018-1
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2016-9 to 2018-1
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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All cause mortality
기간: 2016-9 to 2018-1
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2016-9 to 2018-1
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Mortality caused by infections
기간: 2016-9 to 2018-1
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2016-9 to 2018-1
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Mortality caused by gram-positive infections
기간: 2016-9 to 2018-1
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2016-9 to 2018-1
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Adverse events related to vancomycin
기간: 2016-9 to 2018-1
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2016-9 to 2018-1
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Nephrotoxicity related to vancomycin
기간: 2016-9 to 2018-1
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According to KDIGO, AKI is defined by any of the following:
All adverse events will be assessed and analyzed with WHO-UMC causality criteria by investigators. Adverse events related to vancomycin, especially nephrotoxicity, will be analyzed. |
2016-9 to 2018-1
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Cost-effectiveness of pharmacist intervention
기간: 2016-9 to 2018-1
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The outcome is the incremental cost of preventing one treatment failure infection-related mortality or nephrotoxicity.
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2016-9 to 2018-1
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Duration of using ventilator
기간: 2016-9 to 2018-1
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2016-9 to 2018-1
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Vancomycin dosage
기간: -2016-9 to 201
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-2016-9 to 201
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공동 작업자 및 조사자
수사관
- 수석 연구원: Qinggang Ge, M.D., Peking University Third Hospital
간행물 및 유용한 링크
일반 간행물
- Rybak MJ, Lomaestro BM, Rotschafer JC, Moellering RC Jr, Craig WA, Billeter M, Dalovisio JR, Levine DP. Therapeutic monitoring of vancomycin in adults summary of consensus recommendations from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Pharmacotherapy. 2009 Nov;29(11):1275-9. doi: 10.1592/phco.29.11.1275.
- Ye ZK, Chen YL, Chen K, Zhang XL, Du GH, He B, Li DK, Liu YN, Yang KH, Zhang YY, Zhai SD; Guideline Steering Group, the Guideline Development Group and the Guideline Secretary Group. Therapeutic drug monitoring of vancomycin: a guideline of the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society. J Antimicrob Chemother. 2016 Nov;71(11):3020-3025. doi: 10.1093/jac/dkw254. Epub 2016 Jul 11.
- Matsumoto K, Takesue Y, Ohmagari N, Mochizuki T, Mikamo H, Seki M, Takakura S, Tokimatsu I, Takahashi Y, Kasahara K, Okada K, Igarashi M, Kobayashi M, Hamada Y, Kimura M, Nishi Y, Tanigawara Y, Kimura T. Practice guidelines for therapeutic drug monitoring of vancomycin: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. J Infect Chemother. 2013 Jun;19(3):365-80. doi: 10.1007/s10156-013-0599-4. Epub 2013 May 15. No abstract available.
- Pea F, Bertolissi M, Di Silvestre A, Poz D, Giordano F, Furlanut M. TDM coupled with Bayesian forecasting should be considered an invaluable tool for optimizing vancomycin daily exposure in unstable critically ill patients. Int J Antimicrob Agents. 2002 Nov;20(5):326-32. doi: 10.1016/s0924-8579(02)00188-7.
- Smith C, Burley C, Ireson M, Johnson T, Jordan D, Knight S, Mason T, Massey D, Moss J, Williams K. Clinical trials of antibacterial agents: a practical guide to design and analysis. Statisticians in the Pharmaceutical Industry Working Party. J Antimicrob Chemother. 1998 Apr;41(4):467-80. doi: 10.1093/jac/41.4.467.
연구 기록 날짜
연구 주요 날짜
연구 시작
기본 완료 (예상)
연구 완료 (예상)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (추정)
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
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