Pharmacokinetic/Pharmacodynamic Determinants of Vancomycin Efficacy in Enterococcal Bacteremia
| Autor: | Muhammed Taufiq Bin Jumah, Partha Pratim De, Michael Neely, Sanjay R. Menon, Christine B Teng, Shawn Vasoo |
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| Rok vydání: | 2017 |
| Předmět: |
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 |
| Zdroj: | Antimicrobial agents and chemotherapy. 62(3) |
| ISSN: | 1098-6596 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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