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Title: | Vancomycin AUC/MIC ratio and 30-day mortality in patients with Staphylococcus aureus bacteremia. | Authors: | Howden B.P.;Anderson T.L.;Roberts S.A.;Warren S.J.C.;Gao W.;Johnson P.D.R.;Holmes N.E.;Turnidge J.D.;Munckhof W.J.;Robinson J.O.;Korman T. ;O'Sullivan M.V.N. | Monash Health Department(s): | Infectious Diseases and Clinical Microbiology | Institution: | (Holmes, Howden, Johnson) Austin Centre for Infection Research, Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia (Holmes, Johnson) Department of Medicine, University of Melbourne, Parkville, VIC, Australia (Turnidge) SA Pathology, Women's and Children's Hospital, North Adelaide, SA, Australia (Turnidge) Department of Paediatrics, Pathology and Molecular and Biomedical Science, University of Adelaide, Adelaide, SA, Australia (Munckhof) Infection Management Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia (Munckhof) Department of Medicine, University of Queensland, St. Lucia, QLD, Australia (Robinson) Department of Infectious Diseases and Microbiology, Royal Perth Hospital, Perth, WA, Australia (Korman) Department of Infectious Diseases, Southern Health, Clayton, VIC, Australia (Korman) Department of Medicine, Monash University, Clayton, VIC, Australia (O'Sullivan) Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW, Australia (O'Sullivan) Department of Medicine, University of Sydney, Sydney, NSW, Australia (Anderson, Warren) Department of Infectious Diseases, Royal Hobart Hospital, Hobart, TAS, Australia (Anderson, Warren) Department of Medicine, University of Tasmania, Hobart, TAS, Australia (Roberts) Auckland District Health Board, Auckland, New Zealand (Gao, Howden) Department of Microbiology, Austin Health, Heidelberg, VIC, Australia (Howden, Johnson) Department of Microbiology, Monash University, Clayton, VIC, Australia (Howden) Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC, Australia | Issue Date: | 28-Mar-2013 | Copyright year: | 2013 | Publisher: | American Society for Microbiology (1752 N Street N.W., Washington DC 20036-2904, United States) | Place of publication: | United States | Publication information: | Antimicrobial Agents and Chemotherapy. 57 (4) (pp 1654-1663), 2013. Date of Publication: April 2013. | Abstract: | A ratio of the vancomycin area under the concentration-time curve to the MIC (AUC/MIC) of >= 400 has been associated with clinical success when treating Staphylococcus aureus pneumonia, and this target was recommended by recently published vancomycin therapeutic monitoring consensus guidelines for treating all serious S. aureus infections. Here, vancomycin serum trough levels and vancomycin AUC/MIC were evaluated in a "real-world" context by following a cohort of 182 patients with S. aureus bacteremia (SAB) and analyzing these parameters within the critical first 96 h of vancomycin therapy. The median vancomycin trough level at this time point was 19.5 mg/liter. There was a significant difference in vancomycin AUC/MIC when using broth microdilution (BMD) compared with Etest MIC (medians of 436.1 and 271.5, respectively; P<0.001). Obtaining the recommended vancomycin target AUC/MIC of >=400 using BMD was not associated with lower 30-day all-cause or attributable mortality from SAB (P=0.132 and P=0.273, respectively). However, an alternative vancomycin AUC/MIC of >373, derived using classification and regression tree analysis, was associated with reduced mortality (P=0.043) and remained significant in a multivariable model. This study demonstrated that we obtained vancomycin trough levels in the target therapeutic range early during the course of therapy and that obtaining a higher vancomycin AUC/MIC (in this case, >373) within 96 h was associated with reduced mortality. The MIC test method has a significant impact on vancomycin AUC/MIC estimation. Clinicians should be aware that the current target AUC/MIC of >=400 was derived using the reference BMD method, so adjustments to this target need to be made when calculating AUC/MIC ratio using other MIC testing methods. Copyright © 2013, American Society for Microbiology. All Rights Reserved. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1128/AAC.01485-12 | PubMed URL: | 23335735 [http://www.ncbi.nlm.nih.gov/pubmed/?term=23335735] | ISSN: | 0066-4804 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/27554 | Type: | Article | Subjects: | aged antibiotic therapy area under the curve article broth dilution cohort analysis drug blood level epsilometer test female human major clinical study male adult mortality nonhuman observational study priority journal *staphylococcal bacteremia/dt [Drug Therapy] staphylococcal bacteremia/dt [Drug Therapy] Staphylococcus aureus *vancomycin/cr [Drug Concentration] *vancomycin/dt [Drug Therapy] *vancomycin/pk [Pharmacokinetics] *vancomycin/pd [Pharmacology] minimum inhibitory concentration human major clinical study male minimum inhibitory concentration mortality nonhuman observational study priority journal *staphylococcal bacteremia / *drug therapy staphylococcal bacteremia / drug therapy Staphylococcus aureus aged adult area under the curve article broth dilution cohort analysis drug blood level epsilometer test female antibiotic therapy |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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