Association of vancomycin trough concentration on the treatment outcome of patients with bacteremia caused by Enterococcus species.

Abstract

BACKGROUND:

Pharmacokinetic-pharmacodynamic (PK/PD) targets of vancomycin therapy have been recognized for methicillin-resistant Staphylococcus aureus infections but not for other gram-positive bacterial infections. Therefore, we investigated whether vancomycin concentration targets such as the trough level and ratio of the area under the curve to minimum inhibitory concentration (AUC/MIC) are associated with the treatment outcome in enterococcal bacteremia.

METHODS:

A retrospective cohort analysis enrolled patients with bacteremia caused by vancomycin-susceptible Enterococcus faecium and Enterococcus faecalis who were treated with vancomycin from January 2007 to December 2017 at a tertiary hospital located in Seoul, South Korea. Patients without vancomycin concentrations were excluded from the study. The primary outcome was 28-day all-cause mortality.

RESULTS:

A total of 37 patients were enrolled-26 with E. faecium infection and 11 with E. faecalis infection. The 28-day all-cause mortality rate was 21.6 %. In univariate analysis, vancomycin trough level (≤ 15 µg/mL; p = 0.042), age (p = 0.044), and septic shock (p = 0.049) were associated with 28-day mortality but not AUC24/MIC (> 389; p = 0.479). In multivariate analysis, vancomycin trough concentration (≤ 15 µg/mL; p = 0.041) and younger age (p = 0.031) were associated with 28-day mortality in patients with enterococcal bacteremia.

CONCLUSIONS:

In this study, a vancomycin trough level of 15 µg/mL or lower was associated with 28-day mortality in enterococcal bacteremia. However, relatively large prospective studies are needed to examine the efficacy of vancomycin PK/PD parameters in patients with enterococcal bacteremia.

• Authors: Yujin Sohn, John Hoon Rim, Yunsuk Cho, Jonghoon Hyun, Yaejee Baek, Moohyun Kim, Jung Ho Kim, Hye Seong, Jin Young Ahn, Sang-Guk Lee, Jong-Beack Lim, Su Jin Jeong, Nam Su Ku, Jun Yong Choi, Joon-Sup Yeom, Young Goo Song
• Journal: BMC infectious diseases (BMC Infect Dis) Vol. 21 Issue 1 Pg. 1099 (Oct 26 2021) ISSN: 1471-2334 [Electronic] England
• PMID: 34702193 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s).

Chemical References

• Anti-Bacterial Agents
• Vancomycin

Topics

• Anti-Bacterial Agents (therapeutic use)
• Bacteremia (drug therapy)
• Enterococcus
• Humans
• Methicillin-Resistant Staphylococcus aureus
• Microbial Sensitivity Tests
• Retrospective Studies
• Staphylococcal Infections (drug therapy)
• Treatment Outcome
• Vancomycin (therapeutic use)