Yan Yinghui, Wang Manli, Zhou Mi, Yang Jingxing, Zhu Zengyan, Wang Fengjiao
Department of Pharmacy, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
Front Pediatr. 2025 Jul 21;13:1597306. doi: 10.3389/fped.2025.1597306. eCollection 2025.
Due to a lack of studies on the relationship between vancomycin trough concentration and clinical outcomes in pediatric patients, there is insufficient evidence to provide a unified standard for vancomycin trough concentration for children.
We retrospectively analyzed the data of drug-resistant Gram-positive bacteria isolated from human germfree samples of 66 children diagnosed as definite infectious diseases. Vancomycin was intravenously delivered and the trough concentration was monitored regularly. Receiver operator characteristic curve (ROC curve) was used to explore the relationship between vancomycin trough concentration and treatment outcome.
40.9% of the enrolled pediatric patients had poor outcomes. A vancomycin trough concentration above 6.8 mg/L (OR = 0.014, 95% confidence interval 0.001-0.351, = 0.009) was identified as an independent protective factor, while trough concentrations above 10 mg/L appeared to be necessary to support favorable outcomes within 4 days of treatment in children with secondary bloodstream infections and non-bloodstream infections. 4 (6.35%) patients displayed vancomycin-related acute kidney injury (AKI) with an average trough concentration of 10.85 mg/L, and 50% of them simultaneously used nephrotoxic drugs. Moreover, within 7 days of vancomycin administration, there was a significant decrease in serum creatinine and an increase in creatinine clearance rate, and the children with augmented renal clearance exhibited significantly lower vancomycin trough concentrations and higher proportion of poor outcomes.
A vancomycin trough concentration above 6.8 mg/L is sufficient to support favorable outcomes in children who were infected with drug-resistant Gram-positive bacteria. Compared with vancomycin-associated AKI, augmented renal clearance and subsequent poor antibiotic treatment outcome deserve more attention.
由于缺乏关于儿科患者万古霉素谷浓度与临床结局之间关系的研究，因此没有足够的证据为儿童万古霉素谷浓度提供统一标准。
我们回顾性分析了从66例确诊为明确传染病的儿童无菌样本中分离出的耐万古霉素革兰氏阳性菌的数据。静脉注射万古霉素并定期监测谷浓度。采用受试者工作特征曲线（ROC曲线）探讨万古霉素谷浓度与治疗结局之间的关系。
40.9%的入选儿科患者预后较差。万古霉素谷浓度高于6.8 mg/L（OR = 0.014，95%置信区间0.001 - 0.351，P = 0.009）被确定为独立保护因素，而对于继发血流感染和非血流感染的儿童，似乎需要高于10 mg/L的谷浓度才能在治疗4天内获得良好结局。4例（6.35%）患者出现万古霉素相关急性肾损伤（AKI），平均谷浓度为10.85 mg/L，其中50%同时使用了肾毒性药物。此外，在万古霉素给药7天内，血清肌酐显著下降，肌酐清除率升高，肾清除率增加的儿童万古霉素谷浓度显著降低，不良结局比例更高。
万古霉素谷浓度高于6.8 mg/L足以支持耐万古霉素革兰氏阳性菌感染儿童获得良好结局。与万古霉素相关的AKI相比，肾清除率增加及随后抗生素治疗效果不佳更值得关注。
