Abstract Background The influence of liver disease on the pharmacokinetic profile, the risk of acute kidney injury, and excessive drug exposure in patients treated with vancomycin was examined. Methods A retrospective cohort study was performed with patients discharged from a medical center between January 2011 and June 2018 who received vancomycin therapy. Patients were stratified according to liver dysfunction (no to mild liver dysfunction (NMLD) and moderate to severe liver dysfunction (MSLD) based on the Child–Pugh score. The risk of acute kidney injury was compared between patients who were stratified by the attainment of a target serum trough concentration (10 mg/dL to 20 mg/dL) and the vancomycin ratio formed between the area under the curve and minimum inhibitory concentration. The impact of liver dysfunction and a daily dose of vancomycin on the risk of acute kidney injury and vancomycin AUC:MIC &gt; 600 were tested using logistic regression with and without adjusting for the study variables. Results A total of 408 patients empirically treated with vancomycin were included in this study (237 with NMLD and 171 with MSLD). Mean vancomycin trough concentrations (17.5 ± 8.4 mg/dL versus 15.3 ± 5.2 mg/dL, p = 0.0049) and AUC:MIC ratios (549.4 ± 217.2 versus 497.5 ± 117.3, 0.0065) were significantly higher in the MSLD group when compared to the NMLD group, respectively. Vancomycin clearance was also lower in the MSLD group and corresponded to a longer half-life. The proportion of patients who developed acute kidney injury was greater in patients with MSLD when compared to NMLD (7.6% versus 3.8%, respectively; p = 0.0932); however, the difference was statistically insignificant. Furthermore, supratherapeutic serum trough concentrations and AUC:MIC ratios were more common in the MSLD group versus the NMLD group (27.5% versus 13.9%, p = 0.0007 and 28.7% versus 17.3%, respectively; p = 0.0063). Conclusions MSLD correlates with an increased risk of supratherapeutic vancomycin exposure. Although patients with MSLD had a higher risk of acute kidney injury, the difference was not significant.

Luigi Brunetti

Jong Hwa Song

David Suh

Heui Jae Kim

Yeon Hee Seong

Dae Song Lee

Seung-Mi Lee

Dong-Churl Suh

Annals of Clinical Microbiology and Antimicrobials

ANNALS OF CLINICAL MICROBIOLOGY AND ANTIMICROBIALS 考虑的不仅仅是区域相关性的优质、新颖和国际研究。研究必须包括有关分离株的流行病学和/或临床信息，该期刊涵盖细菌、病毒和真菌的临床微生物学，以及传染病的抗菌治疗。ANNALS OF CLINICAL MICROBIOLOGY AND ANTIMICROBIALS 是一本开放获取的同行评审期刊重点关注有关临床微生物学、传染病和抗菌药物的信息。传染病的管理依赖于正确的诊断和适当的抗菌治疗，考虑到这一点，该杂志旨在改善临床微生物学和抗菌治疗领域的实验室和临床科学之间的交流。此外，该期刊没有空间或访问限制；这确保了期刊能够覆盖尽可能广泛的受众。

The Annals of Clinical Microbiology and Antimicrobials not only focuses on high-quality, novel, and international research with regional relevance but also requires studies to include epidemiological and/or clinical information about isolates. This journal covers clinical microbiology of bacteria, viruses, and fungi, as well as antimicrobial treatment of infectious diseases. As an open-access, peer-reviewed journal, the Annals of Clinical Microbiology and Antimicrobials emphasizes information related to clinical microbiology, infectious diseases, and antimicrobial agents. The management of infectious diseases relies on accurate diagnosis and appropriate antimicrobial treatment; thus, this journal aims to enhance communication between laboratory and clinical sciences in the field of clinical microbiology and antimicrobial therapy. Furthermore, the journal imposes no space or access restrictions, ensuring it can reach the widest possible audience.

《Annals of Clinical Microbiology and Antimicrobials》不仅关注区域相关性的优质、新颖和国际研究，还要求研究必须包含有关分离株的流行病学和/或临床信息。该期刊涵盖细菌、病毒和真菌的临床微生物学，以及传染病的抗菌治疗。作为一本开放获取的同行评审期刊，《Annals of Clinical Microbiology and Antimicrobials》重点关注临床微生物学、传染病和抗菌药物的信息。传染病的管理依赖于正确的诊断和适当的抗菌治疗，因此该杂志旨在改善实验室和临床科学之间的交流，以促进临床微生物学和抗菌治疗领域的发展。此外，该期刊没有空间或访问限制，确保能够覆盖尽可能广泛的受众。

Ann Clin Microbiol Antimicrob

The risk of vancomycin toxicity in patients with liver impairment

Although patients with MSLD had a higher risk of acute kidney injury, the difference was not significant and supratherapeutic serum trough concentrations and AUC:MIC ratios were more common in the MSLD group versus the NMLD group.

Category	Quartile
医学	2
医学, 微生物学	2

The risk of vancomycin toxicity in patients with liver impairment

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