St. Louis College of Pharmacy, St. Louis, MO 63110-1088, USA.
Am J Med. 2010 Dec;123(12):1143-9. doi: 10.1016/j.amjmed.2010.07.025.
conflicting evidence regarding the association of vancomycin serum concentrations with efficacy and toxicity has resulted in controversy regarding optimal target concentrations. Recent publications recommend attaining higher vancomycin trough concentrations of 15 to 20 mg/L for target infections, yet limited research is available assessing the correlation of vancomycin serum concentrations with toxicity. The aim of this study was to evaluate the association between vancomycin serum trough concentrations and nephrotoxicity.
a 2-phase retrospective analysis was completed. Phase 1 evaluated 2493 courses of vancomycin completed between January 2003 and December 2007. The analysis describes a 5-year trend in vancomycin prescribing practices and assesses the association of nephrotoxicity with baseline serum creatinine, vancomycin serum trough concentrations, and duration of vancomycin therapy. Phase 2 examined patients receiving vancomycin therapy during 2007 to evaluate specific risk factors for development of nephrotoxicity.
the proportion of vancomycin serum trough concentrations ≥ 15 mg/L and ≥ 20 mg/L increased significantly over time. Statistical analysis identified vancomycin serum trough concentrations ≥ 14 mg/L, duration of vancomycin therapy ≥ 7 days, and baseline serum creatinine levels ≥ 1.7 mg/dL as independent predictors of nephrotoxicity. Phase 2 analysis again implicated mean vancomycin serum trough concentration as a significant predictor of nephrotoxicity. Nephrotoxicity resolved in 81% (17/21) of cases evaluated.
a higher vancomycin serum trough concentration and prolonged vancomycin therapy are associated with an increased risk of nephrotoxicity. The decision to target increased vancomycin trough concentrations should be based on an assessment of the severity of the infection and must consider the nephrotoxicity risk associated with increased vancomycin levels.
有关万古霉素血清浓度与疗效和毒性之间关联的相互矛盾的证据导致了关于最佳目标浓度的争议。最近的出版物建议针对目标感染获得更高的万古霉素谷浓度 15 至 20mg/L，但评估万古霉素血清浓度与毒性之间相关性的研究有限。本研究旨在评估万古霉素血清谷浓度与肾毒性之间的关系。
进行了 2 期回顾性分析。第 1 阶段评估了 2003 年 1 月至 2007 年 12 月期间完成的 2493 例万古霉素疗程。该分析描述了万古霉素处方实践 5 年的趋势，并评估了肾毒性与基线血清肌酐、万古霉素血清谷浓度和万古霉素治疗持续时间的关系。第 2 阶段检查了 2007 年接受万古霉素治疗的患者，以评估发生肾毒性的特定危险因素。
万古霉素血清谷浓度≥15mg/L 和≥20mg/L 的比例随着时间的推移显著增加。统计分析确定万古霉素血清谷浓度≥14mg/L、万古霉素治疗持续时间≥7 天以及基线血清肌酐水平≥1.7mg/dL 是肾毒性的独立预测因子。第 2 阶段分析再次表明平均万古霉素血清谷浓度是肾毒性的重要预测因子。评估的 21 例病例中有 81%（17/21）的肾毒性得到缓解。
更高的万古霉素血清谷浓度和延长的万古霉素治疗与肾毒性风险增加相关。靶向增加万古霉素谷浓度的决定应基于感染严重程度的评估，并且必须考虑与增加万古霉素水平相关的肾毒性风险。
