Impact of area under the concentration–time curve to minimum inhibitory concentration ratio on vancomycin treatment outcomes in methicillin-resistant Staphylococcus aureus bacteraemia

Song, Kyoung Ho; Kim, Hong Bin; Kim, Hyungsook; Lee, Myung Jin; Jung, Younghee; Kim, Gayeon; Hwang, Jeong Hwan; Kim, Nak Hyun; Kim, Chung Jong; Choe, Pyoeng Gyun; Chung, Jae Yong; Kim, Eu Suk; Park, Kyoung Un; Kim, Nam Joong; Kim, Eui Chong; Oh, Myoung Don

doi:10.1016/j.ijantimicag.2015.09.010

Cited by 50 publications

(40 citation statements)

References 30 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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“…found that a cut‐off trough concentration of 11·1 mg/L could be used to predict clinical efficacy for febrile neutropenia in patients with haematological malignancy. The vancomycin MIC can influence treatment outcomes, and the combination of the AUC 24 and MIC was a better predictor of vancomycin treatment outcomes for MRSA infection …”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of vancomycin treatment outcomes in Chinese paediatric patients with suspected Gram-positive infection

et al. 2016

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“…Despite the AUC/MIC more closely associating with clinical success than serum trough concentrations, it is rarely calculated due to perceived difficulty for bedside clinicians [31, 33]. Therefore, vancomycin serum trough concentrations of 15–20 μg/mL are utilized as a surrogate marker for clinical success [34, 35]. Unfortunately, clinical failure, including mortality, is more likely when the MRSA MIC values to vancomycin are >1 μg/mL due to the inability to achieve the appropriate AUC/MIC target [36–38].…”

Section: Pharmacokinetic and Pharmacodynamic Considerations In The Elmentioning

confidence: 99%

Intravenous Vancomycin Dosing in the Elderly: A Focus on Clinical Issues and Practical Application

et al. 2016

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The elderly population can be divided into three distinct age groups: 65–74 years (young-old), 75–84 years (middle-old), and 85+ years (old-old). Despite evidence of a shift in leading causes for mortality in the elderly from infectious diseases to chronic conditions, infections are still a serious cause of death in this population. These patients are at increased risk due to weakened immune systems, an increased prevalence of underlying comorbidities, and decreased physiologic reserves to fight infection. Additionally, elderly patients, especially adults in institutional settings, are at an increased risk of colonization and subsequent infection with methicillin-resistant Staphylococcus aureus at a rate that is five times higher than in younger individuals, causing an increase in empiric and definitive vancomycin use. Elderly patients have unique characteristics that make dosing vancomycin a challenge for clinicians, such as increased volume of distribution and decreased renal function. Using the best available evidence, it is recommended to initiate lower empiric maintenance doses and monitor vancomycin serum concentrations earlier than steady state to accurately calculate drug elimination and make appropriate dose adjustments.

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Impact of area under the concentration–time curve to minimum inhibitory concentration ratio on vancomycin treatment outcomes in methicillin-resistant Staphylococcus aureus bacteraemia

Cited by 50 publications

References 30 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

Retrospective analysis of vancomycin treatment outcomes in Chinese paediatric patients with suspected Gram-positive infection

Intravenous Vancomycin Dosing in the Elderly: A Focus on Clinical Issues and Practical Application

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