Portal de Periódicos da CAPES

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

2013; Elsevier BV; Volume: 43; Issue: 2 Linguagem: Inglês

10.1016/j.ijantimicag.2013.10.017

1872-7913

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,

Clostridium difficile and Clostridium perfringens research

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 (<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.