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

Abstract 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 ba...

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Veröffentlicht in:International journal of antimicrobial agents 2014-02, Vol.43 (2), p.179-183
Hauptverfasser: Jung, Younghee, Song, Kyoung-Ho, Cho, Jeong eun, Kim, Hyung-sook, Kim, Nak-Hyun, Kim, Taek Soo, Choe, Pyoeng Gyun, Chung, Jae-Yong, Park, Wan Beom, Bang, Ji Hwan, Kim, Eu Suk, Park, Kyoung Un, Park, Sang-Won, Kim, Hong Bin, Kim, Nam Joong, Oh, Myoung-don
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container_end_page 183
container_issue 2
container_start_page 179
container_title International journal of antimicrobial agents
container_volume 43
creator Jung, Younghee
Song, Kyoung-Ho
Cho, Jeong eun
Kim, Hyung-sook
Kim, Nak-Hyun
Kim, Taek Soo
Choe, Pyoeng Gyun
Chung, Jae-Yong
Park, Wan Beom
Bang, Ji Hwan
Kim, Eu Suk
Park, Kyoung Un
Park, Sang-Won
Kim, Hong Bin
Kim, Nam Joong
Oh, Myoung-don
description Abstract 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 ≥72 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 ≥ 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 (
doi_str_mv 10.1016/j.ijantimicag.2013.10.017
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Patients with MRSA bacteraemia between July 2009 and January 2012 were analysed retrospectively. All adult patients treated with vancomycin for ≥72 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 ≥ 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 (&lt;430 by Etest; &lt;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.</description><identifier>ISSN: 0924-8579</identifier><identifier>EISSN: 1872-7913</identifier><identifier>DOI: 10.1016/j.ijantimicag.2013.10.017</identifier><identifier>PMID: 24315788</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - administration &amp; dosage ; Anti-Bacterial Agents - pharmacokinetics ; Anti-Bacterial Agents - pharmacology ; Area Under Curve ; Area under the concentration–time curve ; Bacteraemia ; Bacteremia - drug therapy ; Bacteremia - microbiology ; Female ; Humans ; Infectious Disease ; Male ; Methicillin-resistant Staphylococcus aureus ; Methicillin-Resistant Staphylococcus aureus - drug effects ; Microbial Sensitivity Tests ; Middle Aged ; Minimum inhibitory concentration ; Plasma - chemistry ; Retrospective Studies ; Staphylococcal Infections - drug therapy ; Staphylococcal Infections - microbiology ; Treatment Outcome ; Vancomycin ; Vancomycin - administration &amp; dosage ; Vancomycin - pharmacokinetics ; Vancomycin - pharmacology</subject><ispartof>International journal of antimicrobial agents, 2014-02, Vol.43 (2), p.179-183</ispartof><rights>Elsevier B.V. and the International Society of Chemotherapy</rights><rights>2013 Elsevier B.V. and the International Society of Chemotherapy</rights><rights>Copyright © 2013 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c432t-fd7fe0952d7ad4bf18ff2704d08c815aa9b0cc48a0f9d8417a84426e083f060c3</citedby><cites>FETCH-LOGICAL-c432t-fd7fe0952d7ad4bf18ff2704d08c815aa9b0cc48a0f9d8417a84426e083f060c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijantimicag.2013.10.017$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24315788$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jung, Younghee</creatorcontrib><creatorcontrib>Song, Kyoung-Ho</creatorcontrib><creatorcontrib>Cho, Jeong eun</creatorcontrib><creatorcontrib>Kim, Hyung-sook</creatorcontrib><creatorcontrib>Kim, Nak-Hyun</creatorcontrib><creatorcontrib>Kim, Taek Soo</creatorcontrib><creatorcontrib>Choe, Pyoeng Gyun</creatorcontrib><creatorcontrib>Chung, Jae-Yong</creatorcontrib><creatorcontrib>Park, Wan Beom</creatorcontrib><creatorcontrib>Bang, Ji Hwan</creatorcontrib><creatorcontrib>Kim, Eu Suk</creatorcontrib><creatorcontrib>Park, Kyoung Un</creatorcontrib><creatorcontrib>Park, Sang-Won</creatorcontrib><creatorcontrib>Kim, Hong Bin</creatorcontrib><creatorcontrib>Kim, Nam Joong</creatorcontrib><creatorcontrib>Oh, Myoung-don</creatorcontrib><title>Area under the concentration–time curve to minimum inhibitory concentration ratio as a predictor of vancomycin treatment outcome in methicillin-resistant Staphylococcus aureus bacteraemia</title><title>International journal of antimicrobial agents</title><addtitle>Int J Antimicrob Agents</addtitle><description>Abstract 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 ≥72 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 ≥ 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 (&lt;430 by Etest; &lt;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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - administration &amp; dosage</subject><subject>Anti-Bacterial Agents - pharmacokinetics</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Area Under Curve</subject><subject>Area under the concentration–time curve</subject><subject>Bacteraemia</subject><subject>Bacteremia - drug therapy</subject><subject>Bacteremia - microbiology</subject><subject>Female</subject><subject>Humans</subject><subject>Infectious Disease</subject><subject>Male</subject><subject>Methicillin-resistant Staphylococcus aureus</subject><subject>Methicillin-Resistant Staphylococcus aureus - drug effects</subject><subject>Microbial Sensitivity Tests</subject><subject>Middle Aged</subject><subject>Minimum inhibitory concentration</subject><subject>Plasma - chemistry</subject><subject>Retrospective Studies</subject><subject>Staphylococcal Infections - drug therapy</subject><subject>Staphylococcal Infections - microbiology</subject><subject>Treatment Outcome</subject><subject>Vancomycin</subject><subject>Vancomycin - administration &amp; dosage</subject><subject>Vancomycin - pharmacokinetics</subject><subject>Vancomycin - pharmacology</subject><issn>0924-8579</issn><issn>1872-7913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUkuOEzEQbSEQEwaugMyOTQf_OnZvkEbR8JFGYjGwthx3NanQtoPtjpQdd-A8XIaT4JABAStWJVW9j6peNc0zRpeMstWL3RJ3NhT06OzHJadM1P6SMnWvWTCteKt6Ju43C9pz2epO9RfNo5x3lLJOyO5hc8GlYJ3SetF8u0pgyRwGSKRsgbgYHISSbMEYvn_5Wk1qc04HICUSjwH97AmGLW6wxHT8m0B-FmIzsWSfYEBXMSSO5GCDi_7oMJBSDYuvFBLnUptQ1YiHskWH04ShTZAxl7ofuS12vz1O0UXn5qo5J6hlY12BZMGjfdw8GO2U4cldvWw-vLp-v37T3rx7_XZ9ddM6KXhpx0GNQPuOD8oOcjMyPY5cUTlQ7TTrrO031DmpLR37QUumrJaSr4BqMdIVdeKyeX7W3af4eYZcjMfsYJpsgDhnw2TPFRcrxiq0P0NdijknGM0-obfpaBg1p_TMzvyRnjmldxrV9Cr36Z3NvPEw_Gb-iqsC1mcA1GUPCMlkh1ADGDCBK2aI-F82L_9RcfXuFTZ9giPkXZxTqNc0zGRuqLk9vdHpi5igVCjZix-W6M48</recordid><startdate>20140201</startdate><enddate>20140201</enddate><creator>Jung, Younghee</creator><creator>Song, Kyoung-Ho</creator><creator>Cho, Jeong eun</creator><creator>Kim, Hyung-sook</creator><creator>Kim, Nak-Hyun</creator><creator>Kim, Taek Soo</creator><creator>Choe, Pyoeng Gyun</creator><creator>Chung, Jae-Yong</creator><creator>Park, Wan Beom</creator><creator>Bang, Ji Hwan</creator><creator>Kim, Eu Suk</creator><creator>Park, Kyoung Un</creator><creator>Park, Sang-Won</creator><creator>Kim, Hong Bin</creator><creator>Kim, Nam Joong</creator><creator>Oh, Myoung-don</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140201</creationdate><title>Area under the concentration–time curve to minimum inhibitory concentration ratio as a predictor of vancomycin treatment outcome in methicillin-resistant Staphylococcus aureus bacteraemia</title><author>Jung, Younghee ; Song, Kyoung-Ho ; Cho, Jeong eun ; Kim, Hyung-sook ; Kim, Nak-Hyun ; Kim, Taek Soo ; Choe, Pyoeng Gyun ; Chung, Jae-Yong ; Park, Wan Beom ; Bang, Ji Hwan ; Kim, Eu Suk ; Park, Kyoung Un ; Park, Sang-Won ; Kim, Hong Bin ; Kim, Nam Joong ; Oh, Myoung-don</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c432t-fd7fe0952d7ad4bf18ff2704d08c815aa9b0cc48a0f9d8417a84426e083f060c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - administration &amp; dosage</topic><topic>Anti-Bacterial Agents - pharmacokinetics</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Area Under Curve</topic><topic>Area under the concentration–time curve</topic><topic>Bacteraemia</topic><topic>Bacteremia - drug therapy</topic><topic>Bacteremia - microbiology</topic><topic>Female</topic><topic>Humans</topic><topic>Infectious Disease</topic><topic>Male</topic><topic>Methicillin-resistant Staphylococcus aureus</topic><topic>Methicillin-Resistant Staphylococcus aureus - drug effects</topic><topic>Microbial Sensitivity Tests</topic><topic>Middle Aged</topic><topic>Minimum inhibitory concentration</topic><topic>Plasma - chemistry</topic><topic>Retrospective Studies</topic><topic>Staphylococcal Infections - drug therapy</topic><topic>Staphylococcal Infections - microbiology</topic><topic>Treatment Outcome</topic><topic>Vancomycin</topic><topic>Vancomycin - administration &amp; dosage</topic><topic>Vancomycin - pharmacokinetics</topic><topic>Vancomycin - pharmacology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jung, Younghee</creatorcontrib><creatorcontrib>Song, Kyoung-Ho</creatorcontrib><creatorcontrib>Cho, Jeong eun</creatorcontrib><creatorcontrib>Kim, Hyung-sook</creatorcontrib><creatorcontrib>Kim, Nak-Hyun</creatorcontrib><creatorcontrib>Kim, Taek Soo</creatorcontrib><creatorcontrib>Choe, Pyoeng Gyun</creatorcontrib><creatorcontrib>Chung, Jae-Yong</creatorcontrib><creatorcontrib>Park, Wan Beom</creatorcontrib><creatorcontrib>Bang, Ji Hwan</creatorcontrib><creatorcontrib>Kim, Eu Suk</creatorcontrib><creatorcontrib>Park, Kyoung Un</creatorcontrib><creatorcontrib>Park, Sang-Won</creatorcontrib><creatorcontrib>Kim, Hong Bin</creatorcontrib><creatorcontrib>Kim, Nam Joong</creatorcontrib><creatorcontrib>Oh, Myoung-don</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of antimicrobial agents</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jung, Younghee</au><au>Song, Kyoung-Ho</au><au>Cho, Jeong eun</au><au>Kim, Hyung-sook</au><au>Kim, Nak-Hyun</au><au>Kim, Taek Soo</au><au>Choe, Pyoeng Gyun</au><au>Chung, Jae-Yong</au><au>Park, Wan Beom</au><au>Bang, Ji Hwan</au><au>Kim, Eu Suk</au><au>Park, Kyoung Un</au><au>Park, Sang-Won</au><au>Kim, Hong Bin</au><au>Kim, Nam Joong</au><au>Oh, Myoung-don</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Area under the concentration–time curve to minimum inhibitory concentration ratio as a predictor of vancomycin treatment outcome in methicillin-resistant Staphylococcus aureus bacteraemia</atitle><jtitle>International journal of antimicrobial agents</jtitle><addtitle>Int J Antimicrob Agents</addtitle><date>2014-02-01</date><risdate>2014</risdate><volume>43</volume><issue>2</issue><spage>179</spage><epage>183</epage><pages>179-183</pages><issn>0924-8579</issn><eissn>1872-7913</eissn><abstract>Abstract 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 ≥72 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 ≥ 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 (&lt;430 by Etest; &lt;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.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>24315788</pmid><doi>10.1016/j.ijantimicag.2013.10.017</doi><tpages>5</tpages></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - pharmacokinetics
Anti-Bacterial Agents - pharmacology
Area Under Curve
Area under the concentration–time curve
Bacteraemia
Bacteremia - drug therapy
Bacteremia - microbiology
Female
Humans
Infectious Disease
Male
Methicillin-resistant Staphylococcus aureus
Methicillin-Resistant Staphylococcus aureus - drug effects
Microbial Sensitivity Tests
Middle Aged
Minimum inhibitory concentration
Plasma - chemistry
Retrospective Studies
Staphylococcal Infections - drug therapy
Staphylococcal Infections - microbiology
Treatment Outcome
Vancomycin
Vancomycin - administration & dosage
Vancomycin - pharmacokinetics
Vancomycin - pharmacology
title 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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