Nakayama Hirokazu, Nakamura Yoshitsugu, Tanaka Masayo
Department of Pharmacy, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Chiba, Japan.
J Pharm Health Care Sci. 2025 Apr 14;11(1):32. doi: 10.1186/s40780-025-00438-1.
Despite numerous studies on safety, acute kidney injury (AKI) caused by vancomycin and/or gentamicin remains a persistent medical issue. However, it remains unclear whether vancomycin AUC below 600 mg·h/L in combination with gentamicin trough level at least below 2 µg/mL are reliable indices to reduce the risk of AKI in patients treated with concomitant vancomycin and gentamicin.
The aim was to elucidate the pharmacokinetic factors associated with AKI development in patients receiving concomitant use of vancomycin and gentamicin in the setting of therapeutic drug monitoring (TDM).
A retrospective study was conducted in 15 patients treated with concomitant vancomycin and gentamicin with TDM. The patients were classified into AKI group and no-AKI group. Vancomycin area under the curve (AUC), gentamicin trough levels, and duration of concomitant duration of vancomycin and gentamicin were investigated.
Six (40%) of 15 patients developed AKI during the study period. In AKI group (n = 6), vancomycin AUC was significant higher [median (range) 561 (543‒712) mg·h/L compared to no-AKI group (n = 9), 380 (185‒600) mg·h/L, p = 0.026)], although no significant differences in gentamicin trough level and duration of concomitant vancomycin and gentamicin treatment were found between the two groups. Receiver operating characteristic analysis showed that the best cut-off vancomycin AUC for predicting AKI was 523 mg·h/L, with AUC of 0.852, sensitivity of 1.000 and specificity of 0.778 (p = 0.025).
In patients treated with concomitant vancomycin and gentamicin with trough level below 1-2 µg/mL, vancomycin AUC 530 - 600 mg·h/L is associated with AKI risk.
尽管针对安全性进行了大量研究，但万古霉素和/或庆大霉素所致的急性肾损伤（AKI）仍是一个持续存在的医学问题。然而，万古霉素曲线下面积（AUC）低于600mg·h/L并联合庆大霉素谷浓度至少低于2μg/mL是否为降低接受万古霉素和庆大霉素联合治疗患者发生AKI风险的可靠指标仍不明确。
旨在阐明在治疗药物监测（TDM）背景下接受万古霉素和庆大霉素联合治疗的患者中与AKI发生相关的药代动力学因素。
对15例接受万古霉素和庆大霉素联合治疗并进行TDM的患者进行了一项回顾性研究。将患者分为AKI组和非AKI组。研究了万古霉素曲线下面积（AUC）、庆大霉素谷浓度以及万古霉素和庆大霉素联合使用的持续时间。
15例患者中有6例（40%）在研究期间发生了AKI。在AKI组（n = 6）中，万古霉素AUC显著更高[中位数（范围）为561（543 - 712）mg·h/L，而非AKI组（n = 9）为380（185 - 600）mg·h/L，p = 0.026]，尽管两组之间在庆大霉素谷浓度以及万古霉素和庆大霉素联合治疗的持续时间方面未发现显著差异。受试者工作特征分析表明，预测AKI的最佳万古霉素AUC临界值为523mg·h/L，AUC为0.852，敏感性为1.000，特异性为0.778（p = 0.025）。
在接受万古霉素和庆大霉素联合治疗且谷浓度低于1 - 2μg/mL的患者中，万古霉素AUC 530 - 600mg·h/L与AKI风险相关。
