Kashiwagura Shota, Kamioka Yasuhiro, Seki Masafumi, Koshika Satoshi, Okada Kouji
Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan.
Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai City, Miyagi, Japan.
Infect Drug Resist. 2021 Oct 13;14:4207-4214. doi: 10.2147/IDR.S337058. eCollection 2021.
Low trough concentrations of vancomycin (VCM) are common in patients receiving the drug, because patients are often administered relatively low doses of VCM due to its high potential for renal toxicity. However, the clinical risk factors associated with low VCM trough concentration in relation to renal function are unclear.
Patients at our hospital who received VCM intravenously from January 2018 to December 2020 were analyzed. The patients were divided into two groups based on their renal function: normal and lower renal function, such as estimated glomerular filtration rate (eGFR) ≧60 and <60 mL/min/1.73 m, respectively. In each renal function group, patients' background characteristics, laboratory data and treatments were compared between lower VCM concentration (<10 mg/L) and appropriate VCM concentration (10-20 mg/L) subgroups.
Among 101 patients with normal renal function, 47 and 54 patients, respectively, showed lower and appropriate VCM trough concentrations. Elderly age, short stature, and higher C-reactive protein (CRP) level were significantly more common in the lower VCM concentration group compared with appropriate VCM concentration group. Among the 45 patients with renal dysfunction, 20 and 25 patients, respectively, showed lower and appropriate VCM trough concentrations. CRP levels were significantly higher in lower VCM concentration than appropriate VCM concentration subgroups. Multivariate analysis showed that insufficient total VCM doses and higher CRP might have affected the lower VCM trough concentration in patients with normal renal function.
The results of this study suggest that higher CRP might be one of the risk factors associated with lower VCM concentration in both normal and low renal function patients. Severely ill and emergency patients might receive a lower VCM dose due to underestimation of the acceptable VCM dose.
接受万古霉素（VCM）治疗的患者中，VCM的低谷浓度很常见，因为鉴于VCM具有较高的肾毒性潜力，患者通常接受相对低剂量的VCM治疗。然而，与肾功能相关的VCM低谷浓度的临床风险因素尚不清楚。
对我院2018年1月至2020年12月期间接受静脉注射VCM的患者进行分析。根据肾功能将患者分为两组：肾功能正常组和肾功能较低组，估算肾小球滤过率（eGFR）分别≧60和<60 mL/min/1.73 m²。在每个肾功能组中，比较VCM浓度较低组（<1 mg/L）和VCM浓度适宜组（10 - 20 mg/L）亚组患者的背景特征、实验室数据和治疗情况。
在101例肾功能正常的患者中，分别有47例和54例患者的VCM谷浓度较低和适宜。与VCM浓度适宜组相比，VCM浓度较低组中老年人、身材矮小和C反应蛋白（CRP）水平较高更为常见。在45例肾功能不全的患者中，分别有20例和25例患者的VCM谷浓度较低和适宜。VCM浓度较低组的CRP水平显著高于VCM浓度适宜组亚组。多因素分析表明，VCM总剂量不足和CRP水平较高可能影响了肾功能正常患者的VCM低谷浓度。
本研究结果表明，较高的CRP可能是肾功能正常和肾功能低下患者VCM浓度较低的风险因素之一。重症和急诊患者可能由于对可接受的VCM剂量估计不足而接受较低的VCM剂量。
