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

  • 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

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.


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.

 

 

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Publicado
2018-03-12
Seção
Artigos Originais