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Pharmacokinetic/Pharmacodynamic Determinants of Vancomycin Efficacy in Enterococcal Bacteremia
- Source :
- Antimicrobial agents and chemotherapy. 62(3)
- Publication Year :
- 2017
-
Abstract
- While pharmacokinetic-pharmacodynamic targets for vancomycin therapy are recognized for invasive methicillin-resistant Staphylococcus aureus infections, scant data are available to guide therapy for other Gram-positive infections. A retrospective single-center cohort of patients with Enterococcus bacteremia hospitalized between 1 January 2009 and 31 May 2015 were studied. The average vancomycin AUC 0–24 was computed using a Bayesian approach. The MIC was determined by gradient diffusion (Etest; bioMérieux), and the average AUC 0–24 /MIC value over the initial 72 h of therapy was calculated. We assessed 30-day all-cause mortality as the primary outcome. Classification and regression tree analysis (CART) was used to identify the vancomycin AUC 0–24 /MIC value associated with 30-day mortality. Fifty-seven patients with enterococcal bacteremia (32 E. faecium , 21 E. faecalis , and 4 other Enterococcus spp.) were studied. The median vancomycin MIC was 0.75 mg/liter (range, 0.38 to 3 mg/liter). All-cause 30-day mortality occurred in 10 of 57 patients (17.5%). A CART-derived vancomycin AUC/MIC Etest value of ≥389 was associated with reduced mortality ( P = 0.017); failure to achieve this independently predicted 30-day mortality (odds ratio, 6.83 [95% confidence interval = 1.51 to 30.84]; P = 0.01). We found that a vancomycin AUC/MIC Etest value of ≥389 achieved within 72 h was associated with reduced mortality. Larger, prospective studies are warranted to verify the vancomycin pharmacodynamic targets associated with maximal clinical outcomes and acceptable safety.
- Subjects :
- 0301 basic medicine
Male
medicine.medical_specialty
030106 microbiology
Bacteremia
Microbial Sensitivity Tests
Clinical Therapeutics
03 medical and health sciences
Vancomycin
Internal medicine
medicine
Humans
Pharmacology (medical)
Prospective cohort study
Etest
Aged
Retrospective Studies
Pharmacology
Aged, 80 and over
biology
business.industry
Bayes Theorem
Odds ratio
Middle Aged
biology.organism_classification
medicine.disease
Confidence interval
Infectious Diseases
Enterococcus
Pharmacodynamics
Female
business
medicine.drug
Subjects
Details
- ISSN :
- 10986596
- Volume :
- 62
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Antimicrobial agents and chemotherapy
- Accession number :
- edsair.doi.dedup.....7b745a5716c8dedc147e8e4a6400ea2f