Relationship between blood drug concentration and safety of vancomycin in patients with orthopedic infection determined by ultra-performance liquid chromatography-tandem mass spectrometry

doi:10.12307/2026.240

Abstract

Abstract: BACKGROUND: Vancomycin is widely used as a first-line drug for treating methicillin-resistant Staphylococcus aureus infections in orthopedic perioperative infection prevention and treatment. However, its narrow therapeutic window and large individual differences make blood drug concentration monitoring crucial for ensuring efficacy and safety.
OBJECTIVE: To establish the ultra-performance liquid chromatography-tandem mass spectrometry method to determine the concentration of vancomycin in plasma, and explore the correlation of blood drug concentration changes with clinical efficacy and acute renal impairment.
METHODS: Totally 200 orthopedic patients with bone infection who were hospitalized in Beijing Jishuitan Hospital Guizhou Hospital from January 2020 to May 2022 were selected. Blood drug concentration was measured by ultra-performance liquid chromatography-tandem mass spectrometry. Renal function indexes (blood creatinine and urea nitrogen) were monitored, and the clinical efficacy and acute renal impairment of patients with different blood drug concentration levels were analyzed.
RESULTS AND CONCLUSION: (1) The established ultra-performance liquid chromatography-tandem mass spectrometry method showed a linear range of 0.5-120.0 μg/mL (R²=0.997), with an intra-day relative standard deviation of 4.82%-6.57%, an inter-day relative standard deviation of 10.2%-12.3%, and an accuracy of 97.3%-106%. (2) The clinical effective rate in the group with a blood drug concentration of 10-20 μg/mL (82%) was significantly higher than that in the group with a blood drug concentration of < 10 μg/mL (67%) (P < 0.05). (3) The incidence of renal function impairment in the group with a trough blood drug concentration of > 20 μg/mL (35.0%) was significantly higher than that in the 10-20 μg/mL group (16.0%) and the < 10 μg/mL group (6.7%) (P < 0.05). (4) It is suggested that the established ultra-performance liquid chromatography-tandem mass spectrometry method is sensitive and accurate, and can be used for clinical monitoring of vancomycin blood concentration. Maintaining the blood drug concentration within the range of 10-20 μg/mL can achieve the best clinical efficacy and reduce the risk of nephrotoxicity. Monitoring blood drug concentration is of great significance for guiding individualized drug administration.

Key words: vancomycin, ultra-high performance liquid chromatography-tandem mass spectrometry, blood drug concentration monitoring, clinical efficacy, renal impairment, orthopedic infection, individualized treatment

CLC Number:

Wang Shili, Luo Yuan, Qiao Li, Yang Yonghong, Zhang Yujie, Zhang Shun. Relationship between blood drug concentration and safety of vancomycin in patients with orthopedic infection determined by ultra-performance liquid chromatography-tandem mass spectrometry[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(21): 5494-5502.

Figures/Tables 7

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