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<p>Achieving optimal vancomycin trough concentrations in vivo is crucial to its therapeutic effectiveness. This study was a retrospective, single-center, observational cohort analysis designed to further investigate factors affecting vancomycin trough levels and adverse reactions in pediatric patients with infections, building upon previous research on the rational pediatric use. Additionally, we explored the relationship between vancomycin trough levels and clinical symptom improvement in children infected with Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA). The findings demonstrated that initial vancomycin dosing regimens, as well as serum albumin, hemoglobin, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels, did not differ significantly among the three trough concentration groups: target (10–20&#xa0;mg/L), high (≥ 20&#xa0;mg/L), and low (&lt; 10&#xa0;mg/L) (<i>P</i> &gt; 0.05). The estimated glomerular filtration rate (GFR) values at treatment initiation were 108.4 (87.8–163.7), 95.2 (65.8–144.3), and 149.8 (95.3–201.6) for the three groups, respectively (<i>P</i> &lt; 0.05). Multiple linear regression identified GFR as the most predictive variable for vancomycin trough concentration, showing a negative linear correlation with the initial GFR value in children undergoing vancomycin treatment (<i>R</i><sup>2</sup> = 0.1565, <i>P</i> = 0.014). For children with MRSA infections, the time to normalization of infection markers and the time to negative microbial cultures were shorter in the target and high trough concentration groups compared to the low trough concentration group (<i>P</i> &lt; 0.05). However, the incidence of acute kidney injury during hospitalization was higher in the high concentration group compared to the target and low concentration groups. Therefore, vancomycin trough concentrations in pediatric patients are inversely related to GFR levels. There were no statistically significant differences in the rates of acute liver injury, thrombocytopenia, neutropenia, or 30-day mortality among the three groups (<i>P</i> &gt; 0.05).</p><p><i>Conclusion</i>:&#xa0;For children with MRSA infections, clinical effectiveness is superior at target and high vancomycin trough concentrations; however, elevated trough concentrations are linked to an increased risk of acute kidney injury. Clinically, vancomycin should be administered at lower doses as recommended by guidelines.</p>

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Single-center study of vancomycin treatment in children with infection: influencing factors of plasma trough concentration and assessment of clinical effectiveness

  • 期刊论文

  • 发表日期：

    2026年1月10日

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  • Zhongwei Yin,
  • Lu Qing,
  • Yulin Chen,
  • Lina Qiao

摘要

Achieving optimal vancomycin trough concentrations in vivo is crucial to its therapeutic effectiveness. This study was a retrospective, single-center, observational cohort analysis designed to further investigate factors affecting vancomycin trough levels and adverse reactions in pediatric patients with infections, building upon previous research on the rational pediatric use. Additionally, we explored the relationship between vancomycin trough levels and clinical symptom improvement in children infected with Methicillin-resistant Staphylococcus aureus (MRSA). The findings demonstrated that initial vancomycin dosing regimens, as well as serum albumin, hemoglobin, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels, did not differ significantly among the three trough concentration groups: target (10–20 mg/L), high (≥ 20 mg/L), and low (< 10 mg/L) (P > 0.05). The estimated glomerular filtration rate (GFR) values at treatment initiation were 108.4 (87.8–163.7), 95.2 (65.8–144.3), and 149.8 (95.3–201.6) for the three groups, respectively (P < 0.05). Multiple linear regression identified GFR as the most predictive variable for vancomycin trough concentration, showing a negative linear correlation with the initial GFR value in children undergoing vancomycin treatment (R2 = 0.1565, P = 0.014). For children with MRSA infections, the time to normalization of infection markers and the time to negative microbial cultures were shorter in the target and high trough concentration groups compared to the low trough concentration group (P < 0.05). However, the incidence of acute kidney injury during hospitalization was higher in the high concentration group compared to the target and low concentration groups. Therefore, vancomycin trough concentrations in pediatric patients are inversely related to GFR levels. There were no statistically significant differences in the rates of acute liver injury, thrombocytopenia, neutropenia, or 30-day mortality among the three groups (P > 0.05).

Conclusion: For children with MRSA infections, clinical effectiveness is superior at target and high vancomycin trough concentrations; however, elevated trough concentrations are linked to an increased risk of acute kidney injury. Clinically, vancomycin should be administered at lower doses as recommended by guidelines.