Avaliação do serviço de vancocinemia em um hospital universitário da cidade de Manaus, Amazonas

Abstract

Vancomycin is an antibiotic of the class of glycopeptides used as the first choice in the treatment of infections caused mainly by Staphylococcus sp. resistant to oxacillin. However, some controversial points about its efficacy and safety have been reported, particularly regarding fluctuations of their serious levels according to the clinical conditions of the patients, which culminate in the prevalence of subterapetic or toxic doses. Based on these evidences, this study aimed to perform a quantitative and qualitative analysis of the data of vancocinemia in the intensive care units and medical and surgical clinics of Francisca Mendes University Hospital, located in the city of Manaus, Amazonas, in order to contribute to the improvement of this service. This is a cross-sectional, descriptive and retrospective study that used the records and guidelines performed by the unit's clinical pharmacists from August 2017 to November 2018. A total of 254 medical records were considered and, after analysis of the exclusion criteria, 54 were included in the study. With a prevalence of 66% of males and mean age of 48.5 ± 16.5 years. The mean vancomycin concentrations in the voucher period were 41.0 μg / mL with prevalence of high doses in patients with renal insufficiency and in patients who evolved to death. The relationship between means did not demonstrate a link between serum level values and clinical outcomes. From the results it was possible to determine the importance of vancomycin monitoring, which may aid in dose adjustments, providing adequate serum levels and avoiding therapeutic failure. In this case, we suggest a more active participation of the clinical pharmacist from the prescription to the analysis of dose adjustments of the drug as a function of the determined vancocinemia.