背景：Vancomycin為三環糖肽類抗生素(Tricyclic glycopeptide antibiotic )，主要為抑制細菌細胞壁的合成以達到殺菌的作用，臨床上多使用在第一線治療甲氧苯青黴素具抗藥性的金黃色葡萄球菌 (methicillin-resistant Staphylococcus aureus, MRSA)的感染，但因個體間的藥物動力學差異大，必須執行藥物血中濃度監測。根據美國感染症醫學會(Infectious Diseases Society of America, IDSA)2009年的指引，Vancomycin的波谷濃度需大於10 mg/L，以避免抗藥性菌種的產生。另有研究指出，當vancomycin的波谷濃度超過15-20 mg/L時，急性腎損傷的風險顯著增加。因此，本研究希望可以針對使用vancomycin波谷濃度(Cmin)於腎損傷風險因子的影響做進一步的研究。
目的：探討使用vancomycin波谷濃度(Cmin)對於vancomycin相關急性腎損傷(vancomycin-associated acute kidney injury, VA-AKI)的影響，並分析使用vancomycin發生急性腎損傷的其他風險因子(如藥物血中濃度、疾病嚴重度與併用腎毒性風險藥物)。
方法：本研究為回溯性研究，收錄南部某醫學中心2019至2022年間住院病人，在住院期間曾使用vancomycin以靜脈注射途徑治療並執行藥物血中濃度監測。根據vancomycin波谷濃度(Cmin)將病人分為Cmin < 10 mg/L、10 ≤ Cmin < 15 mg/L 、15 ≤ Cmin < 20 mg/L及Cmin ≧ 20 mg/L四組，並以羅吉斯回歸分析使用 vancomycin 後發生急性腎損傷的機率及相關風險因子。
結果：研究共納入1067人，男性佔61.2%，年齡平均為61.38歲。隨著波谷濃度增加，年齡、血清肌酸酐增加，腎絲球過濾率下降，且腎損傷發生率也有增加趨勢。Cmin ≥ 20 mg/L組的腎損傷發生率為22.46 %，而Cmin < 10 mg/L組的發生率為11.45 %。多變量分析結果顯示，Cmin ≥ 20 mg/L組發生腎損傷的風險較Cmin < 10 mg/L組高（OR 2.28, 95% CI 1.15 to 4.76, p=0.0217)。相較於Ward組，ICU住院發生腎損傷的風險OR是3.41 (95% CI 2.29 to 5.08, p<0.0001)。女性風險較男性低(OR 0.62, 95% CI 0.40 to 0.94, p=0.0279)。此外，併用藥物colistin、ARB與cefepime的病人有較高的腎損傷風險。
結論：本研究發現，vancomycin的波谷濃度與vancomycin相關腎損傷的風險顯著相關，波谷濃度越高，腎損傷風險越大。ICU住院病人、男性或併用藥物colistin、ARB與cefepime為vancomycin相關腎損傷的風險因子。

Introduction: This study explored the impact of vancomycin trough concentrations (Cmin) on vancomycin-associated acute kidney injury (AKI), identified AKI risk factors, and compared these factors between ICU and general ward patients.
Methods: This retrospective study included hospitalized patients treated with intravenous vancomycin and serum drug concentration monitoring at a medical center in Taiwan from 2019 to 2022. Patients were categorized into four groups based on vancomycin trough concentrations: < 10 mg/L, 10 ~15 mg/L, 15 ~ 20 mg/L, and ≥ 20 mg/L. Logistic regression analysis was used to determine the probability of developing AKI and to identify related risk factors.
Results: A total of 1,067 patients were included in the study, with males accounting for 61.2%. The incidence of AKI in the Cmin ≥ 20 mg/L group was 22.46%, compared to 11.45% in the Cmin < 10 mg/L group. Multivariate analysis showed that the risk of AKI was higher in the group with Cmin ≥ 20 mg/L (OR 2.28, 95% CI 1.15 to 4.76, p=0.0217) and ICU patients (OR 3.41, 95% CI 2.29 to 5.08, p<0.0001). Females had a lower risk (OR 0.62, 95% CI 0.40 to 0.94, p=0.0279). Additionally, patients co-administered with colistin, ARB, and cefepime had a higher risk of AKI.
Conclusion: This study found that higher vancomycin trough concentrations were associated with a greater risk of AKI. ICU patients, males, and those co-administered with colistin, ARB, and cefepime were identified as risk factors for vancomycin-associated kidney injury.

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