Distribution characteristics of plasma concentration of vancomycin and clinical efficacy in pediatric patients with severe pneumonia and congenital heart disease

Abstract

Objective To analyze the distribution characteristics of vancomycin blood concentration in children with severe pneumonia complicated with congenital heart disease(CHD) and children with simple severe pneumonia after using the same dose vancomycin, and observe the clinical efficacy at the same time. Methods Plasma concentrations in pediatric patients with severe pneumonia complicated with CHD(CHD group) who treated by vancomycin from November 2012 to September 2013 in Shengjing Hospital of China Medical University were collected.Plasma concentrations of children with simple severe pneumonia(control group) treated by vancomycin were also collected at the same period.The blood concentration values and therapeutic effects of the two groups were recorded into the database for statistical analysis.Peak, trough concentrations and efficacy were analyzed by receiver operating characteristic(ROC) curve. Results Twenty-five children with CHD were collected, the average peak concentration was (28.39±6.68)mg/L, the average trough concentration was (13.34±6.62)mg/L.Control group were also 25 cases, the average peak concentration was (16.23±2.50)mg/L and the average trough concentration was (2.77±1.01)mg/L.Both peak and trough concentrations of CHD children were significantly higher than those of the control group (tpeak=8.52, Ppeak<0.05; ttrough=7.89, Ptrough<0.05). In the ROC of peak, trough concentrations and efficacy, area under the curve were 0.74(95%CI 0.547-0.935, P=0.01) and 0.77(95%CI 0.605-0.935, P=0.004) respectively, and the difference was statistically significant. Conclusion Plasma concentrations of vancomycin in children with CHD are generally higher, it is necessery to monitor plasma concentration even under regular doses, to make the application of vancomycin more safe and effective in children with CHD.There is a correlation between plasma concentration of vancomycin and clinical efficacy in children, the higher the blood concentration, the more likely the clinical efficacy is to be effective. Key words: Severe pneumonia; Congenital heart disease; Vancomycin; Serum concentration; Peak concentration; Trough concentration