Retrospective Analysis of Nephrotoxicity and Efficacy of Vancomycin Trough Concentrations in Patients with Severe Pneumonia

OBJECTIVE To estimate the target trough concentration in patients with severe pneumonia, and to investigate the predict value of the target trough concentration between clinical efficacy and nephrotoxicity. METHODS In this retrospective, single-center, observational cohort study, 110 hospitalized patients with severe pneumonia who were treated with vancomycin due to bacteriologically documented or presumptive Gram-positive infections were analyzed. RESULTS A significant difference in the first trough concentration of vancomycin was observed between the response and non-response groups, and between the nephrotoxicity and non-nephrotoxicity groups. Multiple logistic regression analyses identified the first trough concentration as the only independent variable associated with clinical efficacy and nephrotoxicity of vancomycin. The areas under the ROC curves were 0.82 and 0.80 for clinical efficacy and nephrotoxicity, respectively. The cut-off values of the first trough concentration were 7.9 μg·mL^-1 for clinical efficacy (sensitivity 88%, specificity 62%) and 21.1 μg·mL^-1 for nephrotoxicity (sensitivity 73%, specificity 86%). CONCLUSION These results suggest a relationship of trough vancomycin concentration with clinical efficacy and incidence of nephrotoxicity. Serum concentration monitoring is required to achieve bset outcomes and the goal of individualized treatment of vancomycin.