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Updated: Jul 5, 2026
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Nanomechanics of Drug-target Interactions and Antibacterial Resistance Detection
Published on: October 25, 2013
Vancomycin penetration into intra-abdominal compartments: Site concentration disparities and implications for dose
Huifang Zhang1, Yaxin Fan2, Fangqing Zhou1
1Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
International Journal of Antimicrobial Agents
|July 3, 2026
Summary
Vancomycin effectively penetrates ascites but poorly penetrates bile in critically ill patients with Gram-positive complicated intra-abdominal infections. Site-specific therapeutic drug monitoring (TDM) showed improved clinical outcomes, warranting further study.
Area of Science:
- Pharmacokinetics and Pharmacodynamics
- Infectious Diseases
- Critical Care Medicine
Background:
- Complicated intra-abdominal infections (cIAI) caused by Gram-positive bacteria often require vancomycin treatment.
- Optimizing vancomycin dosing through therapeutic drug monitoring (TDM) is crucial for efficacy and safety in critically ill patients.
- Understanding vancomycin penetration into infection sites like ascites and bile is essential for effective treatment.
Purpose of the Study:
- To determine vancomycin concentrations in ascites and bile fluid in critically ill patients with Gram-positive cIAI.
- To compare clinical outcomes between standard serum TDM and dual-site (serum and infection site) TDM for vancomycin therapy.
- To evaluate the association between site-specific TDM and vancomycin target attainment.
Main Methods:
- Prospective, single-center observational cohort study of ICU patients with Gram-positive cIAI (2021-2024).
- Patients received vancomycin; TDM was performed on serum (serum-only group) or both serum and infection site fluid (dual-TDM group).
- Primary outcome: vancomycin TDM concentration and target attainment; Secondary outcomes: efficacy, safety, and penetration rates.
Main Results:
- Vancomycin exposure was significantly higher in ascites (11.67 mg/L) than in bile (4.31 mg/L) (P < 0.0001).
- Penetration rates were 65.99% in ascites versus 18.50% in bile (P < 0.0001).
- Dual-TDM was associated with higher clinical (88% vs 57.14%) and microbiological (92% vs 57.14%) efficacy compared to serum-only TDM (P < 0.05).
Conclusions:
- Vancomycin shows adequate penetration into ascites but limited penetration into bile in cIAI.
- Dual-TDM was linked to improved target attainment and clinical benefit in this exploratory study.
- Further randomized trials are needed to confirm the utility of site-specific TDM for vancomycin in biliary infections.
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