Background
Vancomycin is often required to treat methicillin resistant Staphylococcus aureus (MRSA) bacteremia in children. Treatment failure occurs in up to 50% of adults and is associated with a 24 hour area under the curve/minimum inhibitory concentration (AUC24h/MIC) <400. We sought to identify patient factors associated with vancomycin AUC and whether AUC24h/MIC <400 was predictive of treatment failure in children.
Methods
Hospitalized children <18 years of age with MRSA bacteremia receiving vancomycin were included in a retrospective cohort study. AUC24h was calculated using a validated PK model. Factors such as age, gender, underlying conditions, presence of foreign bodies, patient site of infection, and markers of illness severity were examined for an association with vancomycin AUC, and AUC24h/MIC was evaluated for an association with treatment failure.
Results
Subjects requiring intensive care (ICU) support were significantly more likely to have higher vancomycin AUC24h and AUCavg than those subjects not needing ICU support. While vancomycin serum trough concentrations are predictive of vancomycin AUC, sub-optimal exposure of vancomycin occurred in almost 20% of subjects despite trough concentrations within the target range. A relationship between vancomycin AUC24h/MIC and treatment failure could not be established.
Conclusions
To ensure optimal AUC/MIC pharmacodynamic index, especially in critically ill patients, estimation of the AUC is critical.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.