급성 폐렴 환자에서 Vancomycin clinical pharmacokinetic consulting service의 효과 분석

다국어 초록 (Multilingual Abstract)

Vancomycin is a glycopeptide antibiotic used to treat infection of resistant organisms such as meticillin-resistant staphylococcus aureus(MRSA). Vancomycin has narrow therapeutic level and toxicity is observed near therapeutic level, in this reason, vancomycin is one of the major medicines covered by clinical pharmacokinetic consulting service(CPCS).
This study was designed to evaluate nephrotoxicity preventive effect and improvement of therapeutic effect of vancomycin CPCS in patients with acute pneumonia.
Subjects of this study are patients who received vancomycin more than 5days for acute pneumonia from December 2015 to september 2017 in Konyang University Hospital.
Total 91 patients(63 males, 28 females, average 71.07±13.70 years in age, average 192.92±7.99cm in height , average 55.52±10.90kg in weight, 52 ICU inpatients) were retrospectively reviewed. Subject patients were categorized two group, 44 patients who were received vancomycin CPCS belong to CPCS group and 47 patients who did not receive vancomycin CPCS belong to non-CPCS group.
Treatment effect was evaluated through C-reactive protein(CRP) and nephrotoxicity was judged on the basis of serum creatinine(SCr) values.
The number of patients with treatment failure was lower in patients undergoing CPCS(n=4(9.09%) and 10(21.27%) respectively; p=0.039). But The difference in treatment duration between the CPCS group and the non-CPCS group was 0.75 days, which was not statistically significant.(p=0.93)
The number of patients with acute kidney injury(AKI) was lower when the CPCS was conducted(n=15(37.50%) versus 22(52.38%); p=0.17), but the number of patients who discontinued vancomycin treatment due to AKI similar in two group.(n=5(12.50%) in CPCS group, n=4(9.50%) in non-CPCS group; p=0.47). And the number of patients with uncontrolled AKI(n=9(22.50%) versus n=13(30.95%); p=0.39) were smaller in CPCS group and the uncontrolled degree of those patients when the renal impairment occurred were smaller when CPCS was conducted. However, these results were not statistically significant.
The 30-day mortality rate was statistically significantly lower in the CPCS group.(n=6(13.64%) versus n=15(31.94%); p=0.038)
If CPCS prevents treatment failure or nephrotoxicity, it can reduce the patient charge of 174,550~1,985,130 won or 113,370~2,034,760 won respectively, and the shortening of the 0.75-day treatment period resulted in savings of 28,890~​​125,760 won per person.
In conclusion, vancomycin CPCS does not shorten the duration of treatment but prevents treatment failure and is effective in preventing nephrotoxicity. If CPCS prevents treatment failure and nephrotoxicity, the patient can save considerable medical costs.

목차 (Table of Contents)

• 서론 1
• 1. 연구의 배경 1
• 2. 임상약동학 자문 업무 (Clinical Pharmacokinetic Consulting Service, CPCS) 4
• 3. C-Reactive Protein(CRP) 6
• 4. 연구의 목적 7
• 대상 및 방법 8
• 1. 연구 대상 8
• 2. Vancomycin CPCS 업무 수행방법 9
• 3. 연구 과정 14
• (1) Vancomycin CPCS으로 인한 치료실패 예방과 치료기간 단축효과 분석 14
• (2) Vancomycin CPCS으로 인한 신독성 예방효과 분석 16
• (3) 폐렴의 치료실패 혹은 AKI 발생으로 인한 사망률 분석 17
• (4) CPCS 업무 수행으로 인한 의료비 절감효과 분석 18
• 4. 분석 방법 19
• 결과 및 고찰 20
• 1. 결과 20
• (1) 연구 대상 20
• (2) Vancomycin CPCS으로 인한 치료 실패 예방과 치료기간 단축효과 분석 22
• (3) Vancomycin CPCS으로 인한 신독성 예방효과 분석 24
• (4) 폐렴의 치료실패 혹은 AKI 발생으로 인한 사망률 분석 26
• (5) CPCS 업무 수행으로 인한 의료비 절감효과 분석 27
• 5-1) 치료실패 환자에서 치료기간 연장에 따라 증가한 비용 분석 29
• 5-2) AKI 발생 환자에서 치료기간 연장에 따라 증가한 비용 분석 32
• 5-3) Vancomycin CPCS로 인한 치료기간 단축에 따라 절감된 비용 분석 34
• 2. 고찰 36
• 3. 결론 43
• 참고문헌 45
• 영문초록 50