Low Correlation Between Vancomycin Area Under the Curve Over 24 Hours to the MIC (AUC/MIC ratio) and the Trough Concentration at Steady State in Methicillin-Resistant Staphylococcus Aureus Pneumonia
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background : Vancomycin is a mainstay of treatment of serious methicillin-resistant Staphylococcus aureus (MRSA) infections. The recently published guideline on vancomycin monitoring recommends that a vancomycin loading dose can be considered and an individualized target AUC/MIC ratio of 400-600 and should be advocated to achieve clinical efficacy while improving safety in patients with the suspected or definitive MRSA infections. Methods : To evaluate the correlation between the vancomycin trough concentration and the area under the curve over 24 hours to the MIC (AUC/MIC) ratio according to the guideline recently published. A retrospective cohort study was conducted on adult patients treated for MRSA proven pneumonia with the vancomycin. We enrolled patients administered with the vancomycin loading dose before the maintenance dose and the monitored vancomycin trough concentrations at the steady state in medical intensive care units April 2017-March 2020. We calculated the vancomycin AUC/MIC ratio based on the trough concentration measured for each patient using the Bayesian software. The difference between the microbiological cure, all-cause mortality, and nephrotoxicity for each group was studied. Results : There was low correlation between the vancomycin AUC/MIC and trough concentration in MRSA pneumonia. A total of 35 patients were included. Thirty-one patients (88.6%) were above the AUC/MIC ratio 400, while 19 patients (54.3%) were in the trough range above 15 mcg/ ml. Although there was a weak correlation between the vancomycin trough concentration and the AUC/MIC ratio (r=0.427, p=0.010), the vancomycin through concentrations at the steady state within the therapeutic ranges did not mean the vancomycin AUC/MIC ratio within the therapeutic ranges (p=0.580). No significant difference was observed in the microbiological cure, all-cause mortality, and incidence of acute kidney injury in each group. Conclusion : The trough level-guided monitoring of the vancomycin should be replaced by the AUC/MIC ratio-guided monitoring in the clinical practice in Korea.
Abstract
Background : Vancomycin is a mainstay of treatment of serious methicillin-resistant Staphylococcus aureus (MRSA) infections. The recently published guideline on vancomycin monitoring recommends that a vancomycin loading dose can be considered and an individualized target AUC/MIC ratio of 400-600 and should be advocated to achieve clinical efficacy while improving safety in patients with the suspected or definitive MRSA infections. Methods : To evaluate the correlation between the vancomycin trough concentration and the area under the curve over 24 hours to the MIC (AUC/MIC) ratio according to the guideline recently published. A retrospective cohort study was conducted on adult patients treated for MRSA proven pneumonia with the vancomycin. We enrolled patients administered with the vancomycin loading dose before the maintenance dose and the monitored vancomycin trough concentrations at the steady state in medical intensive care units April 2017-March 2020. We calculated the vancomycin AUC/MIC ratio based on the trough concentration measured for each patient using the Bayesian software. The difference between the microbiological cure, all-cause mortality, and nephrotoxicity for each group was studied. Results : There was low correlation between the vancomycin AUC/MIC and trough concentration in MRSA pneumonia. A total of 35 patients were included. Thirty-one patients (88.6%) were above the AUC/MIC ratio 400, while 19 patients (54.3%) were in the trough range above 15 mcg/ ml. Although there was a weak correlation between the vancomycin trough concentration and the AUC/MIC ratio (r=0.427, p=0.010), the vancomycin through concentrations at the steady state within the therapeutic ranges did not mean the vancomycin AUC/MIC ratio within the therapeutic ranges (p=0.580). No significant difference was observed in the microbiological cure, all-cause mortality, and incidence of acute kidney injury in each group. Conclusion : The trough level-guided monitoring of the vancomycin should be replaced by the AUC/MIC ratio-guided monitoring in the clinical practice in Korea.
참고문헌 (15)
- Rybak M, "Therapeutic monitoring of vancomycin in adult patients : a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists", Advanced Drug Delivery Reviews, 66(1), pp.82~98 (2009)
- Rybak MJ, "Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections : A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists", American Journal of Health-System Pharmacy, 77(11), pp.835~864 (2020)
- Reardon J, "Vancomycin loading doses : a systematic review", Annals of Pharmacotherapy, 49(5), pp.557~565 (2015)
- Fuchs A, "Benchmarking therapeutic drug monitoring software : a review of available computer tools", Clinical Pharmacokinetics, 52(1), pp.9~22 (2013)
- Pai MP, "Innovative approaches to optimizing the delivery of vancomycin in individual patients", Advanced Drug Delivery Reviews, 77, pp.50~57 (2014)
- Mohr JF, "Point : Vancomycin is not obsolete for the treatment of infection caused by methicillin-resistant Staphylococcus aureus", Clinical Infectious Diseases, 44(12), pp.1536~1542 (2007)
- Patel N, "Vancomycin:we can’t get there from here", Clinical Infectious Diseases, 52(8), pp.969~974 (2011)
- Neely MN, "Are vancomycin trough concentrations adequate for optimal dosing", Antimicrobial Agents and Chemotherapy, 58(1), pp.309~316 (2014)
- Rybak MJ, "The pharmacokinetic and pharmacodynamic properties of vancomycin", Clinical Infectious Diseases, 42(Suppl 1), pp.S35~S39 (2006)
- Brown J, "Vancomycin AUC24", MIC ratio in patients with complicated bacteremia and infective endocarditis due to methicillin-resistant Staphylococcus aureus and its association with attributable mortality during hospitalization, 2012, pp.56(2), 634~638
- Jung Y, "Area under the concentration-time curve to minimum inhibitory concentration ratio as a predictor of vancomycin treatment outcome in methicillin-resistant Staphylococcus aureus bacteraemia", International Journal of Antimicrobial Agents, 43(2), pp.179~183 (2014)
- Gawronski KM, "A stewardship program’s retrospective evaluation of vancomycin AUC24", MIC and time to microbiological clearance in patients with methicillin-resistant Staphylococcus aureus bacteremia and osteomyelitis, 2013, pp.35(6), 772~779
- Mogle BT, "Implementation of a two-point pharmacokinetic AUC-based vancomycin therapeutic drug monitoring approach in patients with methicillin-resistant Staphylococcus aureus bacteraemia", International Journal of Antimicrobial Agents, 52(6), pp.805~810 (2018)
- Finch NA, "A Quasi-Experiment To Study the Impact of Vancomycin Area under the Concentration-Time Curve-Guided Dosing on Vancomycin-Associated Nephrotoxicity", Antimicrobial Agents and Chemotherapy, 61(12) (2017)
- Casapao AM, "Association between vancomycin day 1exposure profile and outcomes among patients with methicillin-resistant Staphylococcus aureus infective endocarditis", Antimicrobial Agents and Chemotherapy, 59(6), pp.2978~2985 (2015)