Case analysis of hepatotoxicity caused by vancomycin

Objective: To analyze the characteristics and clinical manifestations of liver injury caused by vancomycin, and to provide reference for clinical medication. Methods: : Patients with liver function injury who received vancomycin treatment in the Third Xiangya Hospital of Central South University and Hunan Maternal and Child Health Hospital from 2016 to 2021 were selected for retrospective analysis of their general situation, course of vancomycin, dose, liver function index, severity of liver injury, combined medication, etc. Results: : Of the 4562 patients who received vancomycin, 17 patients were finally included, with an incidence rate of 0.37%. There were 12 males (70.6%) and 5 females (29.4%); age 17-84, average 45.41±20.405. All patients were evaluated with Naranjo’s score, score ≥3. The dosage, time and plasma concentration of vancomycin in patients were analyzed, 9 patients (52.94%) had abnormal liver function when they received vancomycin at the initial dose of 1g Q12h. 14 patients (82.35%) with liver injury were combined with 2 ~ 4 drugs, and severe liver injury occurred in patients who combined with 2 drugs. Occurrence time of liver injury was 2-12 days after the initiation of vancomycin, average 4.53±2.401 days, 16 patients (94.1%) showed abnormal liver function within 7 days after medication, and 2 patients with grade 3-4 liver injury all showed abnormal within 3 days after medication. Only 4 of the 17 patients (23.53%) had vancomycin blood concentration within the normal range, and no correlation was found between blood concentration and severity of liver injury. The correlation between the severity of liver injury and vancomycin was analyzed, none of the patients had allergies such as rash, 2 patients (11.76%) had jaundice and fatigue occurred in 5 patients (29.41%); the remaining 10 patients (58.82%) had no symptoms related to liver injury. All 17 patients showed abnormal AST/ALT, and 9 patients also showed abnormal bilirubin; 15 patients (88.24%) liver injury severity was grade 1, indicating mild hepatic impairment, and no correlation between liver injury severity and creatinine was observed. Among the 17 patients, 1 patient received no intervention, 4 patients stopped taking vancomycin after developing liver damage, and 1 patient reduced dose; 11 patients (64.7%) were treated with hepatinica. Conclusion: Although the study concluded that the incidence of liver injury was not high, the liver toxicity of vancomycin should still be paid attention to and the liver function indicators should be monitored during the clinical use of vancomycin.