Area under the concentration-time curve to minimum inhibitory concentration ratio as a predictor of vancomycin treatment outcome in methicillin-resistant Staphylococcus aureus bacteraemia

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• 作者：Younghee Jung ; Kyoung-Ho Song ; Jeong eun Cho ; Hyung-sook Kim ; Nak-Hyun Kim ; Taek Soo Kim ; Pyoeng Gyun Choe ; Jae-Yong Chung ; Wan Beom Park ; Ji Hwan Bang ; Eu Suk Kim ; Kyoung Un Park ; Sang-Won Park ; Hong Bin Kim ; Nam Joong Kim ; Myoung-don Oh
• 关键词：Vancomycin ; Methicillin-resistant Staphylococcus aureus ; Bacteraemia ; Area under the concentration&ndash ; time curve ; Minimum inhibitory concentration
• 刊名：International Journal of Antimicrobial Agents
• 出版年：February, 2014
• 年：2014
• 卷：43
• 期：2
• 页码：179-183
• 全文大小：404 K

文摘

There have been few clinical studies on the association between the 24-h area under the concentration-time curve (AUC₂₄) to minimum inhibitory concentration (MIC) ratio and vancomycin treatment outcomes in methicillin-resistant Staphylococcus aureus (MRSA) infections. Patients with MRSA bacteraemia between July 2009 and January 2012 were analysed retrospectively. All adult patients treated with vancomycin for 鈮?2 h without dialysis were included. The MIC was determined by Etest and broth microdilution (BMD). Initial steady-state AUC₂₄ was estimated using a Bayesian model, and the AUC₂₄/MIC cut-off value for differentiating treatment success and failure was calculated by classification and regression tree (CART) analysis. In total, 76 patients were enrolled; vancomycin treatment failure occurred in 20 patients (26.3%). Catheter-related infection was the most frequent (35.5%), followed by surgical site infection (26.3%), whilst 25 (32.9%) had complicated infections. In univariate analysis, decreased MRSA vancomycin susceptibility (MIC 鈮?#xA0;1.5 mg/L) and vancomycin trough levels (15-20 mg/L) were not associated with treatment outcomes. In the CART analysis, low initial vancomycin AUC₂₄/MIC (<430 by Etest; <398.5 by BMD) was associated with a higher treatment failure rate (50.0% vs. 25.0%, P = 0.039 by Etest; 45.0% vs. 23.2%; P = 0.065 by BMD). In multivariate analysis, low initial vancomycin AUC₂₄/MIC was a significant risk factor for treatment failure [adjusted odds ratio (aOR) = 4.39, 95% confidence interval (CI), 1.26-15.35 by Etest; aOR = 3.73, 95% CI 1.10-12.61 by BMD]. In MRSA bacteraemia, a low initial vancomycin AUC₂₄/MIC is an independent risk factor for vancomycin treatment failure.