Retrospective analysis of vancomycin treatment outcomes in Chinese paediatric patients with suspected Gram-positive infection

What is known and objectiveVancomycin is one of the most widely used antibiotics for treating serious Gram-positive infections in children. Few clinical studies have examined the potential risk factors for treatment failure in children receiving vancomycin. The objectives of this study were to evaluate the relationships between vancomycin trough concentration and treatment outcomes in Chinese paediatric patients with suspected Gram-positive infections and to identify baseline characteristics that may affect treatment failure associated with vancomycin use. MethodsA retrospective cohort study was conducted from April 2007 to October 2015. Patients were included in this study if they were <18 years old, had received vancomycin for at least 72 h and had at least one bacterial culture and one serum steady-state vancomycin trough concentration. Treatment outcomes were defined as success or failure. Nephrotoxicity was defined as a serum creatinine (Scr) increase 44.2 mol/L or a 50% increase in baseline Scr for at least two consecutive days. Univariate and multivariate logistic regression analyses were performed to identify risk factors for treatment failure with vancomycin. Results and discussionOne hundred and eighty-two patients were included. Vancomycin treatment failure occurred in 52 patients (28.6%), and the incidence of nephrotoxicity was low. No significant difference was observed in the vancomycin trough concentrations between the treatment success and failure groups. Multivariate logistic regression analyses showed that the vancomycin trough concentration [odds ratio (OR), 1.046; 95% confidence interval (CI), 0.979-1.118; P = 0.179, statistical power: 62.04%)] was not associated with treatment outcome, and only intensive care unit (ICU) admission (OR, 3.808; 95% CI, 1.714-8.465; P = 0.001, statistical power: 90.40%) was found to be independently associated with vancomycin treatment failure. What is new and conclusionOur findings suggest that the vancomycin trough concentration is not associated with treatment outcome. ICU admission is an independent predictor of treatment failure.