ObjectiveTo analyse the influence of factors on the steady-state trough concentration (Ctrough) of vancomycin, especially in patients with augmented renal clearance, and to provide a reference for clinical application.MethodsData on patient demographics, routine blood examination, hepatic function and kidney function were collected from May 2013 to October 2016. A total of 292 patients were enrolled and correlations between Ctroughof vancomycin and other test indices were analysed by SPSS software.ResultsThe patients with augmented renal clearance were significantly younger with relatively lower Ctrough values and higher weight, ALB and PLT compared to others. And age was the most important factor of Ctroughamong subgroups of ARC.ConclusionsInpatients with augmented renal clearance,vancomycin Ctrough was mainly affected by age. Clinicians and pharmacists should adjust the dosage regimen in a timely manner based on therapeutic drug monitoring and these influencing factors.

Augmented Renal Clearance (ARC) refers to the increased renal clearance of circulating solute in critically ill patients. In this study, the analytical research method of transcriptomics combined with metabolomics was used to study the pathogenesis of ARC at the transcriptional and metabolic levels. In transcriptomics, 534 samples from 5 datasets in the Gene Expression Omnibus database were analyzed and 834 differential genes associated with ARC were obtained. In metabolomics, we used Ultra-Performance Liquid Chromatography-Quadrupole Time-of-Flight Mass Spectrometry to determine the non-targeted metabolites of 102 samples after matching propensity scores, and obtained 45 differential metabolites associated with ARC. The results of the combined analysis showed that purine metabolism, arginine biosynthesis, and arachidonic acid metabolism were changed in patients with ARC. We speculate that the occurrence of ARC may be related to the alteration of renal blood perfusion by LTB4R, ARG1, ALOX5, arginine and prostaglandins E2 through inflammatory response, as well as the effects of CA4, PFKFB2, PFKFB3, PRKACB, NMDAR, glutamate and cAMP on renal capillary wall permeability.

Teicoplanin is a glycopeptide antibiotic commonly used to treat Gram-positive bacterial infections in the clinic. The aim of this study was to provide a therapeutic reference for the clinical application and dosage regimen adjustment of teicoplanin by identifying factors associated with its plasma trough concentration (C trough ). A retrospective study was performed on patients with suspected or documented Gram-positive infections who were hospitalized from November 2017 to January 2020 and treated with teicoplanin while undergoing routine therapeutic drug monitoring (TDM). A total of 112 C trough trough measurements were obtained from 72 patients were included in this study. SPSS software was used for correlation analysis and receiver operator characteristic curve (ROC) analysis. The C trough for teicoplanin showed statistically significant relationships (P<0.05) with PLT, S cr , CL cr , eGFR, BUN and Cys-C. ROC curve analysis revealed that CL cr and eGFR were more sensitive and specific for C trough compared to the other factors. These findings should be considered in the clinical application of teicoplanin and for its dosage adjustment.