1. Association of vancomycin trough concentration on the treatment outcome of patients with bacteremia caused by Enterococcus species.
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Sohn, Yujin, Rim, John Hoon, Cho, Yunsuk, Hyun, Jonghoon, Baek, Yaejee, Kim, Moohyun, Kim, Jung Ho, Seong, Hye, Ahn, Jin Young, Lee, Sang-Guk, Lim, Jong-Beack, Jeong, Su Jin, Ku, Nam Su, Choi, Jun Yong, Yeom, Joon-Sup, and Song, Young Goo
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BACTEREMIA , *STAPHYLOCOCCUS aureus infections , *TREATMENT effectiveness , *GRAM-positive bacterial infections , *METHICILLIN-resistant staphylococcus aureus , *ENTEROENDOCRINE cells , *ANTIBIOTICS , *RETROSPECTIVE studies , *VANCOMYCIN , *STAPHYLOCOCCAL diseases , *ENTEROCOCCUS , *MICROBIAL sensitivity tests - Abstract
Background: Pharmacokinetic-pharmacodynamic (PK/PD) targets of vancomycin therapy have been recognized for methicillin-resistant Staphylococcus aureus infections but not for other gram-positive bacterial infections. Therefore, we investigated whether vancomycin concentration targets such as the trough level and ratio of the area under the curve to minimum inhibitory concentration (AUC/MIC) are associated with the treatment outcome in enterococcal bacteremia.Methods: A retrospective cohort analysis enrolled patients with bacteremia caused by vancomycin-susceptible Enterococcus faecium and Enterococcus faecalis who were treated with vancomycin from January 2007 to December 2017 at a tertiary hospital located in Seoul, South Korea. Patients without vancomycin concentrations were excluded from the study. The primary outcome was 28-day all-cause mortality.Results: A total of 37 patients were enrolled-26 with E. faecium infection and 11 with E. faecalis infection. The 28-day all-cause mortality rate was 21.6 %. In univariate analysis, vancomycin trough level (≤ 15 µg/mL; p = 0.042), age (p = 0.044), and septic shock (p = 0.049) were associated with 28-day mortality but not AUC24/MIC (> 389; p = 0.479). In multivariate analysis, vancomycin trough concentration (≤ 15 µg/mL; p = 0.041) and younger age (p = 0.031) were associated with 28-day mortality in patients with enterococcal bacteremia.Conclusions: In this study, a vancomycin trough level of 15 µg/mL or lower was associated with 28-day mortality in enterococcal bacteremia. However, relatively large prospective studies are needed to examine the efficacy of vancomycin PK/PD parameters in patients with enterococcal bacteremia. [ABSTRACT FROM AUTHOR]- Published
- 2021
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