OBJECTIVE： To provide reference for clinical use of vancomycin. METHODS： Medical records of elderly infective patients receiving vancomycin were collected from ICU of our hospital during Jan. 2013-Dec. 2017. Clinical efficacy， bacterial clearance， safety， trough blood concentration distribution were analyzed retrospectively. RESULTS： A total of 959 elderly patients received vancomycin in ICU of our hospital. Totally 237 patients （24.7％） received steady trough concentration monitoring （containing 135 patients with normal renal function， 102 patients with abnormal renal function）. After vancomycin treatment， there were 53 cured patients， 73 valid patients， 36 improved patients and 72 invalid patients， with total response rate of 69.6％. Clinical specimens of 168 patients were detected， with detection rate of 70.9％. The pathogens were mainly methicillin-resistant Staphylococcus aureus and methicillin-resistant S. epidermidis， with bacterial clearance rate of 72.0％. There was no statistical significance in renal function indexes of  237 patients before and after treatment （P＞0.05）. Among 135 patients with normal renal function， 13 patients suffered from abnormal increase of Scr， among which one patient also had rash. After drug withdrawal or reduction， all symptoms were improved. Deterioration of renal function was not found in 102 patients with abnormal renal function after administration. The trough concentration of vancomycin was monitored 370 times in 237 patients （1.56 times per capita） with an average of （10.4±9.7） mg/L. The trough concentration kept in the range of 10-20 mg/L in 85 patients （35.8％） and monitored 121 times in total （32.7％）. The failure rate of monitoring was 67.3％. The times of trough concentration monitoring， the proportion of drug adjustment， the proportion of trough concentration ＞20 mg/L in patients with normal renal function were significantly lower than patients with abnormal renal function； the proportion of patients with normal renal function whose trough concentration ranged 10-15 and ＞15-20 mg/L was significantly higher than that of corresponding patients with abnormal renal function （P＜0.05）. CONCLUSIONS： The proportion of vancomycin trough concentration monitoring in ICU elderly infective patients is not high in our hospital and the response rate of treatment is low. The trough concentration of vancomycin in most patients is not within the effective range， and the distribution of trough concentration in patients with different renal function is different. The trough concentration of vancomycin in patients with abnormal renal function may be higher. Vancomycin blood concentration monitoring should be actively carried out in clinical practice， and drug regimens should be adjusted according to the monitoring results and individual characteristics of patients to ensure the safety and effectiveness of treatment.