Relationship between blood drug concentration and safety of vancomycin in patients with orthopedic infection determined by ultra-performance liquid chromatography-tandem mass spectrometry

Wang Shili; Luo Yuan; Qiao Li; Yang Yonghong; Zhang Yujie; Zhang Shun

doi:10.12307/2026.240

Abstract：BACKGROUND:Vancomycin is widely used as a first-line drug for treating methicillin-resistant Staphylococcus aureus infections in orthopedic perioperative infection prevention and treatment.However,its narrow therapeutic window and large individual differences make blood drug concentration monitoring crucial for ensuring efficacy and safety. OBJECTIVE:To establish the ultra-performance liquid chromatography-tandem mass spectrometry method to determine the concentration of vancomycin in plasma,and explore the correlation of blood drug concentration changes with clinical efficacy and acute renal impairment. METHODS:Totally 200 orthopedic patients with bone infection who were hospitalized in Beijing Jishuitan Hospital Guizhou Hospital from January 2020 to May 2022 were selected.Blood drug concentration was measured by ultra-performance liquid chromatography-tandem mass spectrometry.Renal function indexes(blood creatinine and urea nitrogen)were monitored,and the clinical efficacy and acute renal impairment of patients with different blood drug concentration levels were analyzed. RESULTS AND CONCLUSION:(1)The established ultra-performance liquid chromatography-tandem mass spectrometry method showed a linear range of 0.5-120.0 μg/mL(R²=0.997),with an intra-day relative standard deviation of 4.82%-6.57%,an inter-day relative standard deviation of 10.2%-12.3%,and an accuracy of 97.3%-106%.(2)The clinical effective rate in the group with a blood drug concentration of 10-20 μg/mL(82%)was significantly higher than that in the group with a blood drug concentration of<10 μg/mL(67%)(P<0.05).(3)The incidence of renal function impairment in the group with a trough blood drug concentration of>20 μg/mL(35.0%)was significantly higher than that in the 10-20 μg/mL group(16.0%)and the<10 μg/mL group(6.7%)(P<0.05).(4)It is suggested that the established ultra-performance liquid chromatography-tandem mass spectrometry method is sensitive and accurate,and can be used for clinical monitoring of vancomycin blood concentration.Maintaining the blood drug concentration within the range of 10-20 μg/mL can achieve the best clinical efficacy and reduce the risk of nephrotoxicity.Monitoring blood drug concentration is of great significance for guiding individualized drug administration.