Objective To explore the correlation between vancomycin serum trough concentrations,24-hour area under the curve (AUC24h),and neonatal acute kidney injury (AKI),and determine the optimal exposure thresholds for rational therapy in neonates.Methods A retrospective analysis was conducted the neonates who received intravenous vancomycin treatment from June 2019 to June 2023.The clinical data were collected,including serum trough concentrations,demographic data,clinical information,and relevant laboratory tests.AUC24h was calculated using Bayesian methods.Spearman correlation coefficient was used to assess the relationship between trough vancomycin concentrations and AUC24h.Receiver Operating Characteristic (ROC) curves and calibration curve were used to evaluate the predictive performance of trough concentrations and AUC24h for AKI.The optimal cutoff value was selected using the Youden index.Multivariable Cox regression analysis was used to examine the correlation between trough concentration cutoff value,AUC24h cutoff value,and AKI.Survival curves of patients were plotted.Log-rank test was used to compare differences in the incidence of AKI between groups.Results A total of 135 cases were included.Overall,8.9％ (12/135) of the patients experienced nephrotoxicity.Nephrotoxic patients showed higher trough vancomycin concentrations (16.10 mg/L vs.12.40 mg/L;P>0.05) and AUC24h (647.53 mg·h/L vs.503.25 mg·h/L;P<0.01) compared to those without AKI.Trough concentrations showed weak correlation with AUC24h (Rho=0.304).ROC curve analysis revealed a higher area under the curve of AUC24h than trough concentrations (0.763 vs.0.608),with Brier scores<0.1.The cutoff value of trough concentration and AUC24h was 24.90 mg/L and 575.78 mg·h/L respectively for AKI.Cox regression analysis demonstrated correlation between trough concentration and AUC24h and AKI risk.Log-Rank tests indicated significant difference in AKI rates for both dichotomized trough concentrations and AUC24h (P<0.01).Conclusions Vancomycin serum trough concentrations and AUC24h,calculated using Bayesian methods,can predict vancomycin-induced nephrotoxicity in neonates.Cutoff value of trough concentration>24.90 mg/L and AUC24h>575.78 mg·h/L can be considered as risk predictors in clinical prescription.

Objective To explore the correlation between vancomycin serum trough concentrations,24-hour area under the curve (AUC24h),and neonatal acute kidney injury (AKI),and determine the optimal exposure thresholds for rational therapy in neonates.Methods A retrospective analysis was conducted the neonates who received intravenous vancomycin treatment from June 2019 to June 2023.The clinical data were collected,including serum trough concentrations,demographic data,clinical information,and relevant laboratory tests.AUC24h was calculated using Bayesian methods.Spearman correlation coefficient was used to assess the relationship between trough vancomycin concentrations and AUC24h.Receiver Operating Characteristic (ROC) curves and calibration curve were used to evaluate the predictive performance of trough concentrations and AUC24h for AKI.The optimal cutoff value was selected using the Youden index.Multivariable Cox regression analysis was used to examine the correlation between trough concentration cutoff value,AUC24h cutoff value,and AKI.Survival curves of patients were plotted.Log-rank test was used to compare differences in the incidence of AKI between groups.Results A total of 135 cases were included.Overall,8.9％ (12/135) of the patients experienced nephrotoxicity.Nephrotoxic patients showed higher trough vancomycin concentrations (16.10 mg/L vs.12.40 mg/L;P>0.05) and AUC24h (647.53 mg·h/L vs.503.25 mg·h/L;P<0.01) compared to those without AKI.Trough concentrations showed weak correlation with AUC24h (Rho=0.304).ROC curve analysis revealed a higher area under the curve of AUC24h than trough concentrations (0.763 vs.0.608),with Brier scores<0.1.The cutoff value of trough concentration and AUC24h was 24.90 mg/L and 575.78 mg·h/L respectively for AKI.Cox regression analysis demonstrated correlation between trough concentration and AUC24h and AKI risk.Log-Rank tests indicated significant difference in AKI rates for both dichotomized trough concentrations and AUC24h (P<0.01).Conclusions Vancomycin serum trough concentrations and AUC24h,calculated using Bayesian methods,can predict vancomycin-induced nephrotoxicity in neonates.Cutoff value of trough concentration>24.90 mg/L and AUC24h>575.78 mg·h/L can be considered as risk predictors in clinical prescription.

Objective To understand the occurrence and main characteristics of medication errors (ME) in Xiamen Maternal and Child Health Hospital.Methods All the ME reports received by the ME submission system of Xiamen Maternal and Child Health Hospital from January 1,2015 to December 31,2017 were collected,and ME characteristics such as the time of occurrence,classification,grade,drugs involved,and triggering factors were analyzed.On the basis of the 9-level grading method (grade A-Ⅰ),ME were further divided into potential errors (including potential error problems and errors that happened but the drugs were not given to patients) and out-door errors (the wrong drugs had been given to patients).Results A total of 18 944 ME reports were collected,including 12 ME that occurred before the link of prescription and did not involve patients and 18 932 ME that occurred in the link of prescription and various links after the prescription.Of the 18 932 ME,231 were out-door errors,which accounted for 1.22％ of overall ME.A total of 3 553 074 patients (number of registrations)were prescribed in the study period in the hospital and the incidences of overall ME and out-door errors were 0.53％ (18 932/3 553 074) and 0.07‰ (231/3 553 074),respectively.The highest incidences of both the potential errors and out-door errors appeared from 13:00 to 13:59 [21.87‰(1 120/51 248);0.18％(9/51 248)].The top 3 ME classes in the 18 944 ME were prescription errors (77.37％,14 657 ME),dispensing and location errors (17.35％,3 286 ME),and omission and delivering errors (2.22％,421 ME).Of the 18 944 ME,6 (0.03％),18 821 (99.35％),111 (0.59％),and 6 (0.03％) ME were grading as A,B,C,and D,respectively,while none was grading as E-Ⅰ.Personnel factor took the first place [59.65％ (11 301/18 944)] in all the triggering factors of ME,followed by environmental factor [17.71％ (3 355/18 944)].Conclusions The incidence of overall ME in Xiamen Maternal and Child Health Hospital was 0.53％ and most of the ME were not serious,which were no harm to patients.The peak time of the ME occurrence lasted from 13:00 to 13:59.Prescription error was the main type of ME and the main trigger factor was personnel factor.Results of the study could help to develop targeted precautions to reduce the occurrence of ME.

Objective To understand the occurrence and main characteristics of medication errors (ME) in Xiamen Maternal and Child Health Hospital.Methods All the ME reports received by the ME submission system of Xiamen Maternal and Child Health Hospital from January 1,2015 to December 31,2017 were collected,and ME characteristics such as the time of occurrence,classification,grade,drugs involved,and triggering factors were analyzed.On the basis of the 9-level grading method (grade A-Ⅰ),ME were further divided into potential errors (including potential error problems and errors that happened but the drugs were not given to patients) and out-door errors (the wrong drugs had been given to patients).Results A total of 18 944 ME reports were collected,including 12 ME that occurred before the link of prescription and did not involve patients and 18 932 ME that occurred in the link of prescription and various links after the prescription.Of the 18 932 ME,231 were out-door errors,which accounted for 1.22％ of overall ME.A total of 3 553 074 patients (number of registrations)were prescribed in the study period in the hospital and the incidences of overall ME and out-door errors were 0.53％ (18 932/3 553 074) and 0.07‰ (231/3 553 074),respectively.The highest incidences of both the potential errors and out-door errors appeared from 13:00 to 13:59 [21.87‰(1 120/51 248);0.18％(9/51 248)].The top 3 ME classes in the 18 944 ME were prescription errors (77.37％,14 657 ME),dispensing and location errors (17.35％,3 286 ME),and omission and delivering errors (2.22％,421 ME).Of the 18 944 ME,6 (0.03％),18 821 (99.35％),111 (0.59％),and 6 (0.03％) ME were grading as A,B,C,and D,respectively,while none was grading as E-Ⅰ.Personnel factor took the first place [59.65％ (11 301/18 944)] in all the triggering factors of ME,followed by environmental factor [17.71％ (3 355/18 944)].Conclusions The incidence of overall ME in Xiamen Maternal and Child Health Hospital was 0.53％ and most of the ME were not serious,which were no harm to patients.The peak time of the ME occurrence lasted from 13:00 to 13:59.Prescription error was the main type of ME and the main trigger factor was personnel factor.Results of the study could help to develop targeted precautions to reduce the occurrence of ME.