Case analysis of hepatotoxicity caused by vancomycin

Area of Science:

• Pharmacology
• Hepatology
• Clinical Medicine

Background:

• Vancomycin, an antibiotic, is associated with a low but observable risk of liver toxicity.
• Clinical manifestations include elevated liver enzymes (AST, ALT), alpha-fetoprotein, and jaundice.
• Understanding vancomycin-induced liver injury (VILI) is essential for clinical guidance.

Purpose of the Study:

• To analyze the clinical features and manifestations of vancomycin-induced liver injury.
• To provide clinical guidance for managing potential liver toxicity associated with vancomycin use.

Main Methods:

• Retrospective analysis of patients with liver injury receiving vancomycin.
• Data collected included patient demographics, vancomycin dosage and duration, liver function indices, injury severity, and concomitant medications.
• Hospitals involved: Third Xiangya Hospital of Central South University and Hunan Maternal and Child Health Hospital (2016-2021).

Main Results:

• An incidence rate of 0.37% (17 out of 4562 patients) for vancomycin-induced liver injury was observed.
• Most patients (82.35%) were on vancomycin with 2-4 other drugs; severe injury occurred with 2 drugs.
• Liver injury typically manifested within 2-12 days (mean 4.53 days), with 94.1% showing abnormalities within 7 days; 23.53% had normal vancomycin blood concentrations.

Conclusions:

• The incidence of vancomycin-induced liver injury is not high but warrants consideration.
• Continuous monitoring of liver function indicators is recommended during vancomycin therapy.
• Clinical vigilance for potential hepatotoxicity is essential, especially with combination drug therapy.