Division of Nephrology and Infectious Diseases, Department of Internal Medicine, AZ Sint-Jan Brugge-Oostende AV, 8000 Brugge, Belgium.
Kidney Int. 2010 May;77(9):760-4. doi: 10.1038/ki.2010.35. Epub 2010 Feb 24.
Vancomycin is a key tool in the treatment of serious Gram-positive infections. A progressive increase in vancomycin resistance with consequent treatment failure has been observed in staphylococci. Therefore, new dosing guidelines advocating much higher vancomycin doses have been issued. Target trough levels of 15-20 microg/ml are proposed. Whether and how these targets can be achieved in patients with chronic kidney disease or those on dialysis are still under evaluation. The higher vancomycin doses to achieve these treatment targets carry a substantial risk for nephrotoxicity. This risk is incremental with higher trough levels and longer duration of vancomycin use. Critically ill patients, patients receiving concomitant nephrotoxic agents, and patients with already compromised renal function are particularly at risk for vancomycin-induced nephrotoxicity.
万古霉素是治疗严重革兰阳性感染的关键工具。葡萄球菌的万古霉素耐药性逐渐增加，导致治疗失败。因此，已经发布了新的剂量指南，主张使用更高的万古霉素剂量。建议目标谷浓度为 15-20μg/ml。在慢性肾脏病或透析患者中，这些目标是否以及如何能够实现仍在评估中。为了达到这些治疗目标而使用更高的万古霉素剂量会带来实质性的肾毒性风险。这种风险随着谷浓度的升高和万古霉素使用时间的延长而增加。危重症患者、同时使用肾毒性药物的患者以及已经存在肾功能受损的患者尤其有发生万古霉素诱导的肾毒性的风险。
