A real-world study of the optimal cut-off value for vancomycin trough concentration associated with outcomes in children infected with drug-resistant Gram-positive bacteria
BackgroundDue to a lack of studies on the relationship between vancomycin trough concentration and clinical outcomes in pediatric patients, there is insufficient evidence to provide a unified standard for vancomycin trough concentration for children.MethodsWe retrospectively analyzed the data of dru...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1597306/full |
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| author | Yinghui Yan Manli Wang Mi Zhou Jingxing Yang Jingxing Yang Zengyan Zhu Fengjiao Wang |
| author_facet | Yinghui Yan Manli Wang Mi Zhou Jingxing Yang Jingxing Yang Zengyan Zhu Fengjiao Wang |
| author_sort | Yinghui Yan |
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| description | BackgroundDue to a lack of studies on the relationship between vancomycin trough concentration and clinical outcomes in pediatric patients, there is insufficient evidence to provide a unified standard for vancomycin trough concentration for children.MethodsWe retrospectively analyzed the data of drug-resistant Gram-positive bacteria isolated from human germfree samples of 66 children diagnosed as definite infectious diseases. Vancomycin was intravenously delivered and the trough concentration was monitored regularly. Receiver operator characteristic curve (ROC curve) was used to explore the relationship between vancomycin trough concentration and treatment outcome.Results40.9% of the enrolled pediatric patients had poor outcomes. A vancomycin trough concentration above 6.8 mg/L (OR = 0.014, 95% confidence interval 0.001–0.351, P = 0.009) was identified as an independent protective factor, while trough concentrations above 10 mg/L appeared to be necessary to support favorable outcomes within 4 days of treatment in children with secondary bloodstream infections and non-bloodstream infections. 4 (6.35%) patients displayed vancomycin-related acute kidney injury (AKI) with an average trough concentration of 10.85 mg/L, and 50% of them simultaneously used nephrotoxic drugs. Moreover, within 7 days of vancomycin administration, there was a significant decrease in serum creatinine and an increase in creatinine clearance rate, and the children with augmented renal clearance exhibited significantly lower vancomycin trough concentrations and higher proportion of poor outcomes.ConclusionA vancomycin trough concentration above 6.8 mg/L is sufficient to support favorable outcomes in children who were infected with drug-resistant Gram-positive bacteria. Compared with vancomycin-associated AKI, augmented renal clearance and subsequent poor antibiotic treatment outcome deserve more attention. |
| format | Article |
| id | doaj-art-3edf04ca49624377a30db468bbeb5696 |
| institution | DOAJ |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj-art-3edf04ca49624377a30db468bbeb56962025-08-20T02:41:11ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-07-011310.3389/fped.2025.15973061597306A real-world study of the optimal cut-off value for vancomycin trough concentration associated with outcomes in children infected with drug-resistant Gram-positive bacteriaYinghui Yan0Manli Wang1Mi Zhou2Jingxing Yang3Jingxing Yang4Zengyan Zhu5Fengjiao Wang6Department of Pharmacy, Children’s Hospital of Soochow University, Suzhou, Jiangsu, ChinaDepartment of Neurology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, ChinaDepartment of Pharmacy, Children’s Hospital of Soochow University, Suzhou, Jiangsu, ChinaNational Key Laboratory of Immunity and Inflammation, Suzhou Institute of Systems Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Suzhou, Jiangsu, ChinaKey Laboratory of Synthetic Biology Regulatory Element, Institute of Systems Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Suzhou, Jiangsu, ChinaDepartment of Pharmacy, Children’s Hospital of Soochow University, Suzhou, Jiangsu, ChinaDepartment of Pharmacy, Children’s Hospital of Soochow University, Suzhou, Jiangsu, ChinaBackgroundDue to a lack of studies on the relationship between vancomycin trough concentration and clinical outcomes in pediatric patients, there is insufficient evidence to provide a unified standard for vancomycin trough concentration for children.MethodsWe retrospectively analyzed the data of drug-resistant Gram-positive bacteria isolated from human germfree samples of 66 children diagnosed as definite infectious diseases. Vancomycin was intravenously delivered and the trough concentration was monitored regularly. Receiver operator characteristic curve (ROC curve) was used to explore the relationship between vancomycin trough concentration and treatment outcome.Results40.9% of the enrolled pediatric patients had poor outcomes. A vancomycin trough concentration above 6.8 mg/L (OR = 0.014, 95% confidence interval 0.001–0.351, P = 0.009) was identified as an independent protective factor, while trough concentrations above 10 mg/L appeared to be necessary to support favorable outcomes within 4 days of treatment in children with secondary bloodstream infections and non-bloodstream infections. 4 (6.35%) patients displayed vancomycin-related acute kidney injury (AKI) with an average trough concentration of 10.85 mg/L, and 50% of them simultaneously used nephrotoxic drugs. Moreover, within 7 days of vancomycin administration, there was a significant decrease in serum creatinine and an increase in creatinine clearance rate, and the children with augmented renal clearance exhibited significantly lower vancomycin trough concentrations and higher proportion of poor outcomes.ConclusionA vancomycin trough concentration above 6.8 mg/L is sufficient to support favorable outcomes in children who were infected with drug-resistant Gram-positive bacteria. Compared with vancomycin-associated AKI, augmented renal clearance and subsequent poor antibiotic treatment outcome deserve more attention.https://www.frontiersin.org/articles/10.3389/fped.2025.1597306/fullchildrenvancomycintrough concentrationsoutcomesoptimal cut-off value |
| spellingShingle | Yinghui Yan Manli Wang Mi Zhou Jingxing Yang Jingxing Yang Zengyan Zhu Fengjiao Wang A real-world study of the optimal cut-off value for vancomycin trough concentration associated with outcomes in children infected with drug-resistant Gram-positive bacteria Frontiers in Pediatrics children vancomycin trough concentrations outcomes optimal cut-off value |
| title | A real-world study of the optimal cut-off value for vancomycin trough concentration associated with outcomes in children infected with drug-resistant Gram-positive bacteria |
| title_full | A real-world study of the optimal cut-off value for vancomycin trough concentration associated with outcomes in children infected with drug-resistant Gram-positive bacteria |
| title_fullStr | A real-world study of the optimal cut-off value for vancomycin trough concentration associated with outcomes in children infected with drug-resistant Gram-positive bacteria |
| title_full_unstemmed | A real-world study of the optimal cut-off value for vancomycin trough concentration associated with outcomes in children infected with drug-resistant Gram-positive bacteria |
| title_short | A real-world study of the optimal cut-off value for vancomycin trough concentration associated with outcomes in children infected with drug-resistant Gram-positive bacteria |
| title_sort | real world study of the optimal cut off value for vancomycin trough concentration associated with outcomes in children infected with drug resistant gram positive bacteria |
| topic | children vancomycin trough concentrations outcomes optimal cut-off value |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1597306/full |
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