Objective: To assess the rate achieving the target vancomycin trough level (VTL) and its influencing factors in critically ill patients. Methods: The retrospective observational study recruited adult patients treated with intravenous vancomycin in the intensive care unit (ICU) at Zhongda Hospital from January 2015 to December 2017. Serum VTL was tested at steady state. Patients' demographics, the sites of infection, microbial culture results, the severity of illness, laboratory data and vancomycin regimen were obtained at the baseline. The rate achieving target VTL (15-20 mg/L) was analyzed based on renal function. Linear regression was performed to determine the influencing factors of VTL. Results: A total of 85 patients were enrolled, among whom only 23.5% (20/85) achieved the target VTL. In patients with normal renal function, the achieving rate was only 11.4% (4/35), and 80.0% (28/35) was lower than the target trough level multiple linear regression analysis showed that procalcitonin (PCT), estimated glomerular filtration rate (eGFR) and acute physiology and chronic health disease classification system Ⅱ (APACHE Ⅱ) score were independent factors associated with VTL. Conclusion: Achieving target VTL in critically ill patients is not satisfactory. Further study to optimize the administration is needed to facilitate prompt attainment of target VTL.
目的： 探讨重症患者万古霉素谷浓度的达标情况及其影响因素。 方法： 纳入2015年1月至2017年12月入住东南大学附属中大医院ICU，接受静脉滴注万古霉素治疗的成人重症患者（年龄≥18岁)。记录万古霉素给药方案，监测稳定状态时万古霉素谷浓度。观察不同肌酐清除率的重症患者万古霉素谷浓度的达标情况。采用线性回归分析重症患者万古霉素谷浓度的影响因素。 结果： 共纳入85例患者，仅23.5%(20/85）的重症患者达到万古霉素目标谷浓度（15~20 mg/L)；肾功能正常的重症患者，仅11.4%(4/35）的患者达到万古霉素目标谷浓度，80.0%(28/35）的肾功能正常患者万古霉素谷浓度低于15 mg/L。简单线性回归分析结果显示，急性生理与慢性健康状况评分Ⅱ（APACHE Ⅱ）、序贯器官功能衰竭评分（SOFA）、感染性休克、去甲肾上腺素剂量、超敏C反应蛋白、降钙素原、尿素氮、血肌酐、估算肾小球滤过率（eGFR）与万古霉素谷浓度显著相关（P<0.05）。多元线性回归分析显示，降钙素原、eGFR、APACHE Ⅱ是万古霉素谷浓度的独立影响因素（P<0.05）。 结论： 重症患者万古霉素谷浓度的不达标率高，降钙素原、eGFR、APACHE Ⅱ是重要的影响因素。.
Keywords: Nephrotoxicity; Pharmacokinetics; Trough level; Vancomycin.