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Journal of Chinese Pharmaceutical Sciences ›› 2020, Vol. 29 ›› Issue (5): 341-354.DOI: 10.5246/jcps.2020.05.032

• Original articles • Previous Articles     Next Articles

A prospective cohort study on the relationship between vancomycin steady-state trough concentration and efficacy and safety in Chinese adults

Chaohui Wu#, Huifen Lin#, Weiwei Lin, Yiwei Liu, Xiang You, Cuihong Lin, Rongfang Lin, Dayong Zeng, Pinfang Huang*   

  1. Department of Pharmacy, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, Fujian, China
  • Received:2020-02-06 Revised:2020-03-13 Online:2020-05-31 Published:2020-04-12
  • Contact: Tel.: +86-591-87981331, E-mail: hpf160323@163.com
  • Supported by:
    Fujian Medical Innovation Project (Grant No. 2017-CX-31); Guidance Project of Fujian Science and Technology Department (Grant No. 2017Y0033).

Abstract:

Clinical guidelines recommend a steady-state vancomycin(VCM) trough concentration (SVTC) of 10–15 mg/L for regular infections and 15–20 mg/L for severe infections. However, clinical trials have shown that increasing SVTC is not beneficial for efficacy, and instead it leads to nephrotoxicity. To verify whether increasing the SVTC results in improved clinical outcomes with sustainable adverse effects, we prospectively determined its correlation with clinical efficacy and safety. The participants included patients hospitalized with Gram-positive bacterial infections from March 2017 through October 2018. The patients were classified into group I (SVTC<10 mg/L), II (10≤SVTC≤20 mg/L), or III (SVTC>20 mg/L). Clinical, microbiological, and laboratory data were collected. Clinical outcomes between group I and IIwere matched after propensity score matching (PSM). A total of 331 patients were included in this study. Clinical failure occurred in 59 (29%) of 204 patients on day 14, with no significant differencebetween groups I and II (P = 0.535). Infection recurred at 28 d in 62 (30%) of 204 patients, and no significant difference ininfection recurrence was observed between both the groups (log-rank, P = 0.674). Except for a significant increase in the incidence of acute kidney injury in group II, no significant difference was observed between two groups for any clinical results. The incidence of adverse events in groups I and II was significantly lower than that in group III (P<0.001). SVTC had an applicable cut-off point at 14.55 mg/L. SVTC was not correlated with VCMclinical efficacy, while it was a good indicator of nephrotoxicity.  

Key words: Vancomycin, Therapeutic drug monitoring, Nephrotoxicity, Propensity score matching

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