title: [The effect of renal clearance on serum trough concentration of vancomycin in elderly patients with severe pneumonia].
abstract: OBJECTIVE
  To investigate the effect of renal clearance on serum trough concentration of vancomycin in elderly patients with severe pneumonia.
  
  
  METHODS
  This was a prospective non-interventional study. Forty-two elderly patients with severe pneumonia and normal level of serum creatinine were enrolled from November 2013 to October 2014. The patients included 25 males and 17 females, aged 60-83 years (median 74 years). The renal clearance was measured, and the vancomycin regimen and rate of serum trough concentration achieving guideline-recommended target of 15-20 mg/L were investigated. The factors influencing trough concentration of vancomycin were analyzed using the general linear model.
  
  
  RESULTS
  The vancomycin regimens were 1 g/ 12 h (17 cases), 0.5 g/8 h (14 cases) and 0.5 g/12 h (11 cases), and their median and range of serum concentrations were 14.9(2.4-28.5)mg/L, 16.2(2.8-27.8)mg/L and 11.6 (5.9-19.9) mg/L, respectively. The guideline-recommended target trough concentration of 15-20 mg/L was reached in only 10 patients, while trough concentration lower than 15 mg/L was found in 22 patients and higher than 20 mg/L in 10 patients. General linear model analysis showed that creatinine clearance rate(CCR) and dose of vancomycin per kilogram of body weight per day were independent influencing factors for trough concentration (both P<0.05). There were 8 patients with CCR≥130 ml·min(-1)·(1.73 m(2))(-1) (augmented renal clearance), 22 patients with 70≤CCR<130 ml·min(-1)·(1.73 m(2))(-1) and 12 patients with CCR<70 ml·min(-1)·(1.73 m(2))(-1,) and vancomycin trough concentration below 15 mg/L was found in 7, 11 and 4 patients, respectively.
  
  
  CONCLUSIONS
  CCR was an independent influencing factor for trough concentration of vancomycin, and augmented renal clearance increased the risk of subtherapeutic trough concentration of vancomycin.
authors.affiliation: Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Q T
authors.initials: QT
authors.lastname: Zhou
authors.forename: B
authors.initials: B
authors.lastname: He
authors.forename: N
authors.initials: N
authors.lastname: Shen
authors.forename: L N
authors.initials: LN
authors.lastname: Sun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000097:blood / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007668:Kidney / Q000378:metabolism*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy*; D011446:Prospective Studies; D012189:Retrospective Studies; D014640:Vancomycin / Q000097:blood / Q000493:pharmacokinetics*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin