Relationship between vancomycin trough concentrations and incidence of nephrotoxicity in critically ill patients

doi:10.3969/j.issn.1002-1949.2014.11.016

Abstract：Objective To explore the relationship between vancomycin trough concentrations and incidence of nephrotoxicity in critically ill patients.Methods This was a prospective randomized controlled trial.Hospitalized patients who received a course of vancomycin therapy between November 2012 and December 2013 in MICU of Lanzhou University Second Hospital were prospectively studied. Patients were randomly divided into low trough concentration group ( 5 ~10 mg/L ) and high trough concentration group (10~20 mg/L) .The effective rate and incidence of nephrotoxicity were compared, and the incidence of nephrotoxicity associated with the different vancomycin trough concentrations, in addition other risk factors for development of nephrotoxicity were analyzed.Results Of the 83 patients in the study, 36 in the group of low trough concentration (5~10 mg/L) and 47 in the group of high trough concentration (10~20 mg/L),there were significant differences between two groups in clinical response (77.8%vs.95.7%, P<0.05).No significant difference was observed between two groups in toxicity (5.5% vs.8.5%, P =0.394).Independent predictors of vancomycin -induced nephrotoxicity includedage (OR=1.17;95%CI 1.01~1.36), APACHEⅡ score (OR=1.48;95%CI 1.02-2.14), duration of vancomycin therapy≥14 days (OR=1.15;95%CI 1.02~1.31), and concomitant other nephrotoxic agents (OR=1.38; 95%CI 1.03 -1.85).Conclusion The higher vancomycin trough concentration has better clinical response compared with the lower trough concentration.Moreover incidence of nephrotoxicity is not apparent increase concomitantly. Age, APACHEⅡscore, duration of vancomycin therapy≥14 days, and concomitant other nephrotoxic agents are probably risk factors for vancomycin-induced nephrotoxicity.