Area under the concentration–time curve to minimum inhibitory concentration ratio as a predictor of vancomycin treatment outcome in methicillin-resistant Staphylococcus aureus bacteraemia

Jung, Younghee; Song, Kyoung-Ho; Cho, Jeong Eun; Kim, Hyung-Sook; Kim, Nak-Hyun; Kim, Taek Soo; Choe, Pyoeng Gyun; Chung, Jae‐Yong; Park, Wan Beom; Bang, Ji Hwan; Kim, Eu Suk; Park, Kyoung Un; Park, Sang-Won; Kim, Hong Bin; Kim, Nam Joong; Oh, Myoung‐don

doi:10.1016/j.ijantimicag.2013.10.017

Cited by 88 publications

(71 citation statements)

References 14 publications

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“…In light of the above-mentioned literature, high VAN-MIC may be associated with increased risk of mortality in high-inoculum MRSA infections. However, although vancomycin MIC may influence the outcome in specific high-risk MRSA infections, the vancomycin area under the time-concentration curve over MIC ratio may be more accurate than just the MIC, since it takes into account the pharmacokinetic (PK) characteristics of vancomycin when treating MRSA infections (10,12).…”

Section: Discussionmentioning

confidence: 99%

Impact of Vancomycin MIC on Treatment Outcomes in Invasive Staphylococcus aureus Infections

Song

Kim

Cho

et al. 2017

Antimicrob Agents Chemother

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There are conflicting data on the association of vancomycin MIC (VAN-MIC) with treatment outcomes in Staphylococcus aureus infections. We investigated the relationship between high VAN-MIC and 30-day mortality and identified the risk factors for mortality in a large cohort of patients with invasive S. aureus (ISA) infections, defined as the isolation of S. aureus from a normally sterile site. Over a 2-year period, 1,027 adult patients with ISA infections were enrolled in 10 hospitals, including 673 (66%) patients with methicillin-resistant S. aureus (MRSA) infections. There were 200 (19.5%) isolates with high VAN-MIC (Ն1.5 mg/liter) by Etest and 87 (8.5%) by broth microdilution (BMD). The all-cause 30-day mortality rate was 27.4%. High VAN-MIC by either method was not associated with all-cause 30-day mortality, and this finding was consistent across MIC methodologies and methicillin susceptibilities. We conclude that high VAN-MIC is not associated with increased risk of all-cause 30-day mortality in ISA infections. Our data support the view that VAN-MIC alone is not sufficient evidence to change current clinical practice.

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Section: Discussionmentioning

confidence: 99%

Impact of Vancomycin MIC on Treatment Outcomes in Invasive Staphylococcus aureus Infections

Song

Kim

Cho

et al. 2017

Antimicrob Agents Chemother

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“…Data for patient sex, age, onset of bacteremia, first positive blood culture in the intensive care unit (ICU), nosocomial or community acquisition of the bacteremia with a history of previous health care contact (30), primary site of infection, and antibiotic treatment were collected prospectively (31,32). The following data were retrospectively reviewed for this study: Charlson's comorbidity weighted index (33), the McCabe and Jackson classification of underlying illness (classified as rapidly fatal when death was expected within days or weeks, ultimately fatal when death was expected within months or years, and nonfatal when death was not expected), steroid use (equivalent to 20 mg of prednisolone per day Ն1 week) or chemotherapy within 30 days, presence of neutropenia (absolute neutrophil count, Ͻ500/l), severity of illness as measured by the Pitt bacteremia score (34) and sequential organ failure assessment (SOFA) score (35), presentation with septic shock, eradication of the infection foci, and in-hospital death.…”

Section: Methodsmentioning

confidence: 99%

“…Individual 24-h area under the concentration-time curve (AUC 24 ) values were calculated using the Pharmacokinetic system (PKS) version 1.10 (Abbott Laboratories), which uses a two-compartment volume clearance model with the maximum a posteriori probability Bayesian approach, as previously reported (32,45). The patients who met the following criteria were excluded from the AUC 24 analysis: (i) died within 72 h after index culture, (ii) received renal replacement therapy, (iii) received vancomycin for Ͻ72 h, (iv) did not receive vancomycin within 5 days of index culture, and (v) were not checked for vancomycin serum concentration within the first 5 days of treatment.…”

Section: Microbiological Analysesmentioning

confidence: 99%

agr Dysfunction Affects Staphylococcal Cassette Chromosome mec Type-Dependent Clinical Outcomes in Methicillin-Resistant Staphylococcus aureus Bacteremia

Kang

Cho

Choi

et al. 2015

Antimicrob Agents Chemother

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“…However, it must be noted that the vancomycin MIC for S. aureus varies depending on the testing method used. Etest yields MICs of 0.5-to 1.5-log 2 dilutions higher than those determined by broth microdilution (BMD) (10,(14)(15)(16)(17)(18)(19). In this review, unless otherwise noted, all of the AUC/MIC ratios are Etest measures; Etest is the recommended method for measuring the MIC for MRSA bloodstream infection isolates (18).…”

Section: Vancomycin Pharmacodynamics and Its Implications For Drug Momentioning

confidence: 99%

“…Although several pharmacodynamic parameters have been proposed to determine vancomycin activity, data from experimental and clinical studies have selected the area under the curve (AUC)/ MIC ratio as the best parameter to predict the effectiveness of vancomycin (4,(7)(8)(9). The target consensus of an AUC/MIC ratio of Ն 400 for MRSA infections is supported by in vitro data, animal models, and clinical studies that have related an AUC/MIC ratio of 350 to 400 to successful outcome (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, it must be noted that the vancomycin MIC for S. aureus varies depending on the testing method used.…”

Section: Vancomycin Pharmacodynamics and Its Implications For Drug Momentioning

confidence: 99%

Optimizing the Clinical Use of Vancomycin

Álvarez

López-Cortés

Molina

et al. 2016

Antimicrob Agents Chemother

190

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Pharmacists published specific guidelines about vancomycin dosage and monitoring. However, these guidelines have not been updated in the past 6 years. This review analyzes the new available information about vancomycin published in recent years regarding pharmacokinetics and pharmacodynamics, serum concentration monitoring, and optimal vancomycin dosing in special situations (obese people, burn patients, renal replacement therapy, among others). Vancomycin efficacy is linked to a correct dosage which should aim to reach an area under the curve (AUC)/MIC ratio of >400; serum trough levels of 15 to 20 mg/liter are considered a surrogate marker of an AUC/MIC ratio of >400 for a MIC of <1 mg/liter. For Staphylococcus aureus strains presenting with a MIC >1 mg/liter, an alternative agent should be considered. Vancomycin doses must be adjusted according to body weight and the plasma trough levels of the drug. Nephrotoxicity has been associated with target vancomycin trough levels above 15 mg/liter. Continuous infusion is an option, especially for patients at high risk of renal impairment or unstable vancomycin clearance. In such cases, vancomycin plasma steady-state level and creatinine monitoring are strongly indicated. Vancomycin has traditionally been used as a first-line agent for treating methicillin-resistant Staphylococcus aureus (MRSA) and other Gram-positive beta-lactam-resistant bacteria (1), which are frequent etiologies of severe health-related infections (2, 3).Although the effectiveness of vancomycin is supported by more than 5 decades of use and multiple studies, the clinical and microbiological scenario in which it is used is always changing. Attaining an appropriate dosage of vancomycin for S. aureus infections might be difficult due to the clinical impact of the creep in the MIC of vancomycin and heteroresistance among MRSA strains, or due to complex pharmacokinetic and pharmacodynamic (PK/PD) situations. In this context, the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), and the Society of Infectious Diseases Pharmacists (SIDP) introduced a practice guideline in 2009 (4), marking a milestone in vancomycin therapy. However, several questions, such as the optimal dosing in some special clinical situations (e.g., with renal replacement therapies or in burn patients or obese patients), the role of continuous infusion, or the renal toxicity when the suggested vancomycin serum levels are achieved, remain unanswered. The present review mainly focuses on these issues. VANCOMYCIN PHARMACODYNAMICS AND ITS IMPLICATIONS FOR DRUG MONITORINGThe killing effect of vancomycin is characterized by a slow mode of action and is further hampered by a large bacterial inoculum, a stationary growth phase, and anaerobic conditions (5, 6). Although several pharmacodynamic parameters have been proposed to determine vancomycin activity, data from experimental and clinical studies have selected the area under the curve (AUC)/ MIC ratio as the best parameter to predict the...

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Area under the concentration–time curve to minimum inhibitory concentration ratio as a predictor of vancomycin treatment outcome in methicillin-resistant Staphylococcus aureus bacteraemia

Cited by 88 publications

References 14 publications

Impact of Vancomycin MIC on Treatment Outcomes in Invasive Staphylococcus aureus Infections

Impact of Vancomycin MIC on Treatment Outcomes in Invasive Staphylococcus aureus Infections

agr Dysfunction Affects Staphylococcal Cassette Chromosome mec Type-Dependent Clinical Outcomes in Methicillin-Resistant Staphylococcus aureus Bacteremia

Optimizing the Clinical Use of Vancomycin

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