Influencing factors of the first serum concentration of vancomycin in patients with peritoneal dialysis-related peritonitis

doi:10.12092/j.issn.1009-2501.2026.09.008

Abstract

Abstract:

AIM: To investigate the factors influencing the first serum concentration of vancomycin and its relationship to clinical efficacy in patients with peritoneal dialysis-related peritonitis (PDRP) receiving intraperitoneal administration. METHODS: We collected clinical data from 37 PDRP patients treated at The First Affiliated Hospital Of Soochow University between January 2021 and August 2024. All patients received 1 g intraperitoneal vancomycin and underwent serum concentration monitoring. Blood samples were drawn 0.5 h before the second dose to determine the first serum concentration. RESULTS: Seventeen patients with a prior history of peritonitis had a significantly higher first serum concentration [11.22(9.46,11.93) μg/mL] than 20 patients without such history [8.66(7.84,9.51) μg/mL; P<0.01]. Logistic regression identified that both prior peritonitis history and dosing interval duration were independent factors affecting the first serum concentration (P<0.01). A history of peritonitis elevates the first serum concentration at any dosing interval, whereas dosing interval significantly impacts concentrations only in patients without such a history. Before and after vancomycin treatment, there was no significant difference between the high-concentration group and the low-concentration group in the cell components of peritoneal fluid or time to negative culture conversion (P>0.05). Both groups showed significant reductions in the cell components of peritoneal fluid and C-reactive protein (CRP) levels post-treatment compared to baseline (P<0.05). Post-treatment CRP levels were significantly lower in the low-concentration group than in the high-concentration group (P<0.05). CONCLUSION: A history of prior peritonitis and the length of the dosing interval significantly affect the first serum concentration of intraperitoneal vancomycin in PDRP patients; However, the absolute first serum concentration level does not appear to influence clinical efficacy or time to culture negativity.

Key words: peritoneal dialysis-related peritonitis, vancomycin, serum concentration, influential factor

CLC Number:

Yumeng JIANG, Jianzhong LI, Yongfu HANG, Youjing YANG, Shasha TAO, Kun HU, Deyu XU, Guoyuan LU. Influencing factors of the first serum concentration of vancomycin in patients with peritoneal dialysis-related peritonitis[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2026, 31(9): 1221-1230.

Figures/Tables 10

References 24

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Baseline characteristics	Dosing interval 48 h group	Dosing interval 72 h group	P
Dialysis duration (month)	38(19,47)	34(20,98)	0.673
Scr (μmol/L)	1184.10(628.50,1382.05)	946.45(783.80,1134.68)	0.126
CysC (mg/L)	7.12(5.73,8.16)	7.07(5.57,8.17)	0.933
Urea (mmol/L)	24.00(14.85,26.30)	22.40(16.90,29.20)	0.768
UA (μmol/L)	351.00(274.80,464.00)	327.60(279.28,401.13)	0.399
Urine volume (mL/24 h)	0(0,865)	0(0,125)	0.418
Kt/V	1.56(1.44,1.73)	1.68(1.37,1.88)	0.593
D/P	0.68(0.62,0.75)	0.69(0.61,0.75)	0.994
Peritoneal dialysate nucleated cell count (10⁹/L)	1.056(0.423,5.366)	1.562(0.396,4.712)	0.978
Percentage of neutrophils in dialysate (%)	86.0(79.4,90.3)	83.7(74.4,90.1)	0.663
Peripheral blood WBC count (10⁹/L)	7.20(4.57,9.22)	6.84(5.08,8.72)	0.966
Peripheral blood neutrophil percentage (%)	75.4(68.4,83.8)	78.2(67.0,83.5)	0.536
CRP (mg/L)	12.93(10.06,50.34)	27.38(14.25,49.55)	0.126
History of peritonitis infection (%)			0.699
No	7(50.00)	13(56.52)
Yes	7(50.00)	10(43.48)

Baseline characteristics	Dosing interval 48 h group	Dosing interval 72 h group	P
Dialysis duration (month)	38(19,47)	34(20,98)	0.673
Scr (μmol/L)	1184.10(628.50,1382.05)	946.45(783.80,1134.68)	0.126
CysC (mg/L)	7.12(5.73,8.16)	7.07(5.57,8.17)	0.933
Urea (mmol/L)	24.00(14.85,26.30)	22.40(16.90,29.20)	0.768
UA (μmol/L)	351.00(274.80,464.00)	327.60(279.28,401.13)	0.399
Urine volume (mL/24 h)	0(0,865)	0(0,125)	0.418
Kt/V	1.56(1.44,1.73)	1.68(1.37,1.88)	0.593
D/P	0.68(0.62,0.75)	0.69(0.61,0.75)	0.994
Peritoneal dialysate nucleated cell count (10⁹/L)	1.056(0.423,5.366)	1.562(0.396,4.712)	0.978
Percentage of neutrophils in dialysate (%)	86.0(79.4,90.3)	83.7(74.4,90.1)	0.663
Peripheral blood WBC count (10⁹/L)	7.20(4.57,9.22)	6.84(5.08,8.72)	0.966
Peripheral blood neutrophil percentage (%)	75.4(68.4,83.8)	78.2(67.0,83.5)	0.536
CRP (mg/L)	12.93(10.06,50.34)	27.38(14.25,49.55)	0.126
History of peritonitis infection (%)			0.699
No	7(50.00)	13(56.52)
Yes	7(50.00)	10(43.48)

Variable	Low-serum concentration group	High-serum concentration group	P
Sex (%)			0.742
Male	12(57.14)	10(62.50)
Female	9(42.86)	6(37.50)
Age (years)	46(37,63)	48(37,65)	0.978
BSA (m²)	1.80(1.70,1.96)	1.84(1.56,1.94)	0.391
Dialysis duration (month)	38(19,61)	34(22,94)	0.649
eGFR [mL/(min·1.73 m²)]	5.00(4.05,5.60)	4.40(3.60,6.10)	0.934
Scr (μmol/L)	955.20(829.43,1170.90)	1057.10(573.50,1372.50)	0.772
CysC (mg/L)	7.27(5.37,8.22)	7.12(6.27,7.44)	0.610
Urea (mmol/L)	23.40(18.20,26.10)	20.80(11.80,30.20)	0.363
UA (μmol/L)	373.15(309.15,416.43)	291.70(274.20,394.25)	0.080
ALT (U/L)	12.70(9.43,19.00)	8.50(6.80,15.20)	0.045^*
AST (U/L)	12.20(10.30,17.20)	11.50(9.20,20.40)	0.895
Urine volume (mL/24 h)	0(0,200)	0(0,365)	0.678
Kt/V	1.62(1.40,1.88)	1.57(1.34,1.73)	0.581
D/P	0.70(0.61,0.76)	0.68(0.60,0.73)	0.349
Peritoneal dialysate nucleated cell count (10⁹/L)	0.882(0.313,4.832)	1.182(0.574,5.286)	0.355
Percentage of neutrophils in dialysate (%)	85.0(75.0,92.0)	86.0(76.4,88.4)	0.783
Peripheral blood WBC count (10⁹/L)	6.49(5.15,9.22)	7.20(4.46,8.81)	0.501
Peripheral blood neutrophil percentage (%)	79.8(68.2,83.8)	73.1(63.6,82.5)	0.214
CRP (mg/L)	26.16(12.08,85.2)	15.68(12.45,43.80)	0.155
Bacterial species (%)			0.500
G⁺	11(52.38)	11(68.75)
G^?	10(47.62)	5(31.25)
Dosing interval (h)			0.015^*
48	4(19.05)	10(62.50)
72	17(80.95)	6(37.50)
History of peritonitis (%)			0.022^*
No	15(71.43)	5(31.25)
Yes	6(28.57)	11(68.75)

Variable	Low-serum concentration group	High-serum concentration group	P
Sex (%)			0.742
Male	12(57.14)	10(62.50)
Female	9(42.86)	6(37.50)
Age (years)	46(37,63)	48(37,65)	0.978
BSA (m²)	1.80(1.70,1.96)	1.84(1.56,1.94)	0.391
Dialysis duration (month)	38(19,61)	34(22,94)	0.649
eGFR [mL/(min·1.73 m²)]	5.00(4.05,5.60)	4.40(3.60,6.10)	0.934
Scr (μmol/L)	955.20(829.43,1170.90)	1057.10(573.50,1372.50)	0.772
CysC (mg/L)	7.27(5.37,8.22)	7.12(6.27,7.44)	0.610
Urea (mmol/L)	23.40(18.20,26.10)	20.80(11.80,30.20)	0.363
UA (μmol/L)	373.15(309.15,416.43)	291.70(274.20,394.25)	0.080
ALT (U/L)	12.70(9.43,19.00)	8.50(6.80,15.20)	0.045^*
AST (U/L)	12.20(10.30,17.20)	11.50(9.20,20.40)	0.895
Urine volume (mL/24 h)	0(0,200)	0(0,365)	0.678
Kt/V	1.62(1.40,1.88)	1.57(1.34,1.73)	0.581
D/P	0.70(0.61,0.76)	0.68(0.60,0.73)	0.349
Peritoneal dialysate nucleated cell count (10⁹/L)	0.882(0.313,4.832)	1.182(0.574,5.286)	0.355
Percentage of neutrophils in dialysate (%)	85.0(75.0,92.0)	86.0(76.4,88.4)	0.783
Peripheral blood WBC count (10⁹/L)	6.49(5.15,9.22)	7.20(4.46,8.81)	0.501
Peripheral blood neutrophil percentage (%)	79.8(68.2,83.8)	73.1(63.6,82.5)	0.214
CRP (mg/L)	26.16(12.08,85.2)	15.68(12.45,43.80)	0.155
Bacterial species (%)			0.500
G⁺	11(52.38)	11(68.75)
G^?	10(47.62)	5(31.25)
Dosing interval (h)			0.015^*
48	4(19.05)	10(62.50)
72	17(80.95)	6(37.50)
History of peritonitis (%)			0.022^*
No	15(71.43)	5(31.25)
Yes	6(28.57)	11(68.75)

Variable	Univariate logistic		Multivariate logistic
Variable	OR(95%CI)	P	OR(95%CI)	P
Sex (%)
Male	Reference
Female	1.006(0.296,3.422)	0.992
Age (years)	0.999(0.963,1.036)	0.966
BSA (m²)	0.290(0.016,5.194)	0.400
Dialysis duration (month)	1.003(0.992,1.015)	0.597
Scr (μmol/L)	1.117(0.677,1.842)	0.666
CysC (mg/L)	0.943(0.658,1.352)	0.749
Urea (mmol/L)	0.977(0.921,1.036)	0.440
UA (μmol/L)	0.996(0.990,1.001)	0.114
ALT (U/L)	0.961(0.907,1.019)	0.183
AST (U/L)	1.043(0.980,1.110)	0.183
Urine volume (mL/24 h)	1.146(0.695,1.891)	0.593
Kt/V	0.869(0.296,2.546)	0.798
D/P	0.081(0.000,14.740)	0.344
Peritoneal dialysate nucleated cell count (10⁹/L)	0.959(0.834,1.102)	0.552
Percentage of neutrophils in dialysate (%)	0.989(0.947,1.032)	0.604
Peripheral blood WBC count (10⁹/L)	1.059(0.907,1.237)	0.470
Peripheral blood neutrophil percentage (%)	0.973(0.927,1.021)	0.266
CRP (mg/L)	0.986(0.972,1.001)	0.066	0.986(0.969,1.004)	0.138
Bacterial species (%)
G⁺	Reference
G^?	0.450(0.160,1.267)	0.130
Dosing interval (h)
48	Reference
72	0.158(0.052,0.485)	0.001	0.092(0.021,0.400)	0.001
History of peritonitis (%)
No	Reference
Yes	2.719(1.551,4.767)	0.000	3.207(1.568,6.560)	0.001