Association between single trough-based area under the curve estimation of vancomycin and treatment outcome among methicillin-resistant Staphylococcus aureus bacteremia patients

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is amongst the most serious infections of hospitalized patients. MRSA infections are associated with high mortality, especially amongst critically ill patients [1]. A recent clinical guideline recommends a higher serum trough concentration (15-20 μg mL-1) for patients with complicated MRSA bacteremia [2]. Even though a higher trough concentrations has being associated with a better treatment response [3], clinical failure remains common even in patients who have achieved the recommended target for vancomycin trough con

The monitoring of vancomycin: a systematic review and meta-analyses of area under the concentration-time curve-guided dosing and trough-guided dosing

“…1b). Of these, 31 articles were further examined in detail, and finally, five studies [22,23,[40][41][42] included in the meta-analysis for effectiveness evaluation, five studies [15,[43][44][45][46] were included in the meta-analysis for safety evaluation.…”

Relationship Between Mean Vancomycin Trough Concentration and Mortality in Critically Ill Patients: A Multicenter Retrospective Study

“…Surprisingly, most studies found no statistical difference in treatment outcomes according to the VTC level. Two retrospective studies have shown that VTC alone is not a good indicator for vancomycin treatment success among patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia [7,8]. Two other retrospective cohort studies have demonstrated that VTC > 15 mg/L fails to improve the outcomes of patients with MRSA infection [17,18].…”

“…Based on infection models and clinical pharmacokinetic/pharmacodynamic (PK/PD) studies, the area under the concentration-time curve over 24 h/minimum inhibitory concentration (AUC 0 − 24 h /MIC) has been established as the most predictive index to re ect the clinical and microbiological e cacies of vancomycin [6,7]. Bacterial clearance, along with improvements in clinical signs and symptoms, has been suggested to be associated with AUC 0 − 24h /MIC ≥ 400 [8,9]. However, it is di cult to precisely determine multiple serum/tissue vancomycin concentrations during the same dosing interval to calculate the AUC in clinical practice [10].…”

“…Serum vancomycin trough concentration (VTC) monitoring before the fourth dose has been suggested as the most practical method for TDM of vancomycin, as a VTC 15-20 mg/L may achieve an AUC 0 − 24h /MIC ≥ 400 if the MIC is ≤ 1 mg/L [10]. However, plenty of studies have demonstrated that VTC did not have a considerable effect on treatment outcomes [7,8,11,12]. Nevertheless, to our knowledge, those most retrospective and prospective studies only focused on the initial VTC after vancomycin therapy.…”

Relationship Between Mean Vancomycin Trough Concentration and Mortality in Critically Ill Patients: A Multicenter Retrospective Study

“…Based on infection models and clinical pharmacokinetic/pharmacodynamic (PK/PD) studies, the area under the concentration-time curve over 24 h/minimum inhibitory concentration (AUC 0–24 h /MIC) has been established as the most predictive index to reflect the clinical and microbiological efficacies of vancomycin ( Jung et al, 2014 ; Moise-Broder et al, 2004 ). Bacterial clearance, along with improvements in clinical signs and symptoms, has been suggested to be associated with AUC 0–24h /MIC ≥ 400 ( Makmor-Bakry et al, 2019 ; Rybak et al, 2020 ). However, it is difficult to precisely determine multiple serum/tissue vancomycin concentrations during the same dosing interval to calculate the AUC in clinical practice ( Rybak et al, 2009 ).…”