Is Early Monitoring Better? Impact of Early Vancomycin Exposure on Treatment Outcomes and Nephrotoxicity in Patients with Methicillin-Resistant Staphylococcus aureus Infections

Chattaweelarp, Thanawat; Changpradub, Dhitiwat; Punyawudho, Baralee; Thunyaharn, Sudaluck; Santimaleeworagun, Wichai

doi:10.3390/antibiotics9100672

Cited by 12 publications

(14 citation statements)

References 30 publications

(44 reference statements)

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“…However, our study did not evaluate treatment efficacy against MSRA infections and nephrotoxicity according to the estimated vancomycin AUC during the first day [ 20 ]. The clinical benefit of the vancomycin AUC based on Bayesian estimation for MRSA treatment in the first day must be further studied.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin Area under the Curve and Pharmacokinetic Parameters during the First 24 Hours of Treatment in Critically Ill Patients using Bayesian Forecasting

et al. 2020

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Background: Currently, the achievement of the target area under the curve (AUC)/ minimum inhibitory concentration ratio during the first 24 -48 h of treatment is associated with reduced 30-day mortality and greater microbiological eradication in patients with methicillin-resistant Staphylococcus aureus bacteremia. This study aimed to determine the AUC and pharmacokinetic parameters on the first day of vancomycin administration based on the Bayesian theorem to optimize the dosing regimen in critically ill patients. Materials and Methods: This retrospective study included participants meeting the following criteria: 1) ≥18 years old; 2) receipt of at least one dose of vancomycin; 3) measurement of 2 vancomycin serum concentrations during the first 24 h of treatment; and 4) an intensive care unit admission, mechanical ventilator use, or an Acute Physiology and Chronic Health Evaluation II score >15 points. The AUC on day 1 of treatment and the estimated vancomycin pharmacokinetic parameters were measured using PrecisePK software based on the Bayesian theorem. Results: We obtained 132 vancomycin concentrations from 66 patients. The vancomycin pharmacokinetic parameters were as follows: AUC 0-24 , 571.09 (± standard deviation [

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Section: Discussionmentioning

confidence: 99%

Vancomycin Area under the Curve and Pharmacokinetic Parameters during the First 24 Hours of Treatment in Critically Ill Patients using Bayesian Forecasting

et al. 2020

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“…In addition, the AUC thresholds for nephrotoxicity are varied, but more previous evidence showed that nephrotoxicity increased in patients with AUC > 600 mg·h/L. 10 , 11 , 12 , 13 , 14 , 15 , 16 A meta‐analysis reported that the incidence of AKI in AUC‐guided monitoring was lower than in trough‐guided monitoring (OR 0.54, 95% CI 0.28–1.01). 17 Implement AUC‐based dosing protocol using two concentrations can improve the therapeutic vancomycin target and reduce nephrotoxicity.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the mathematical equation and trapezoidal approach for 24 h area under the plasma concentration‐time curve calculation in patients who received intravenous vancomycin in an acute care setting

Chanapiwat

Paiboonvong

Rattanaumpawan

et al. 2023

Pharmacology Res & Perspec

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The current recommendation for therapeutic monitoring of vancomycin has recently suggested AUC‐guided dosing in patients with serious methicillin‐resistant Staphylococcus aureus infections. The study objective was to evaluate mathematical equations and trapezoidal methods for calculating the 24 h area under the plasma vancomycin concentration‐time curve (AUC24). The analysis of plasma vancomycin concentrations was performed in 20 adult patients treated with intravenous vancomycin. For each patient, AUC24 was estimated using two methods including, equation and trapezoidal calculation. The AUC24 from two methods was analyzed for correlation. The correlation between the equation and trapezoidal methods was strong. The coefficient of determination ( R 2 ) values was greater than .99. The two plasma vancomycin concentrations to achieve the highest correlation were concentration at 2.5 to 3 h after starting the infusion and concentration at 1 h before the next dose. Moreover, the AUC24 calculation from trapezoidal and equation methods showed that 19 out of 20 patients (95%) had AUC24 of more than 400 mg·h/L, and more than 50% in this group had AUC24/MIC greater than 600. Of those patients with AUC‐trapezoidal >600, 15.38% of patients had trough under 15 mg/L, 15.38% of patients had trough in the range 15 to 20 mg/L and 69.23% of patients had trough more than 20 mg/L. The results of AUC‐equation were similar to those of the AUC‐trapezoidal method. Our study confirmed that the AUC monitoring is more appropriate than the trough vancomycin concentration. Given these considerations, the AUC‐equation method is better and more practical to use in part of a point‐of‐care treatment, especially in the part of the Bayesian program is not available. The best sampling time point of the peak concentration was 0.5–1 h after 2‐h infusion.

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“…AUC 24 was calculated using the Bayesian method with the APK© software (version 3.5.28, RxKinetics, Plattsburg, MO). As previous studies suggested that the vancomycin AUC/MIC be optimized early in the course of infection [17][18][19], AUC 24 /MIC and C trough during the initial 72 h of treatment were chosen as measures of drug exposure. The average AUC 24 /MIC and C trough values during the initial 72 h were calculated as arithmetic means.…”

Section: Microbiologic and Pharmacokinetic/pharmacodynamic Analysismentioning

confidence: 99%

Pharmacokinetic/pharmacodynamic parameters of vancomycin for predicting clinical outcome of enterococcal bacteremia

et al. 2022

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Purpose To find pharmacokinetic/pharmacodynamic parameters of vancomycin associated with the optimal outcome of severe infection due to Enterococcus species. Methods We retrospectively reviewed enterococcal bacteremia cases treated with vancomycin from January 2015 to December 2020. The primary outcome was 30-day mortality. We calculated cutoff values of the ratio of vancomycin area under the concentration–time curve over 24 h to the minimum inhibitory concentration (AUC24/MIC) and trough concentration (Ctrough) during the initial 72 h of treatment. The optimal cutoff value was determined using the Youden index. Binary variables created based on these cutoffs were further assessed using multivariable analysis. Results A total of 65 patients were included. The majority (87.7%) had solid or hematologic malignancies. Thirty-day mortality and nephrotoxicity occurred in nine (13.4%) and 14 (21.5%) patients, respectively. Both vancomycin AUC24/MIC and Ctrough showed fair performance in predicting 30-day mortality (AUC of receiver-operator curve for AUC24/MIC, 0.712; 95% confidence interval [CI] 0.539–0.886; AUC for Ctrough, 0.760; 95% CI 0.627–0.892; pairwise AUC comparison: p = 0.570). Ctrough ≥ 13.94 μg/mL, but not AUC24/MIC ≥ 504, had a significant association with 30-day mortality after adjusting for confounders (odds ratio, 8.40; 95% CI 1.60–86.62; p = 0.010). Conclusion Mean Ctrough ≥ 13.94 μg/mL during the initial 72 h was associated with higher 30-day mortality in enterococcal bacteremia. Further studies are warranted to elucidate optimal pharmacokinetic targets for enterococcal bacteremia.

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Is Early Monitoring Better? Impact of Early Vancomycin Exposure on Treatment Outcomes and Nephrotoxicity in Patients with Methicillin-Resistant Staphylococcus aureus Infections

Cited by 12 publications

References 30 publications

Vancomycin Area under the Curve and Pharmacokinetic Parameters during the First 24 Hours of Treatment in Critically Ill Patients using Bayesian Forecasting

Vancomycin Area under the Curve and Pharmacokinetic Parameters during the First 24 Hours of Treatment in Critically Ill Patients using Bayesian Forecasting

Comparison of the mathematical equation and trapezoidal approach for 24 h area under the plasma concentration‐time curve calculation in patients who received intravenous vancomycin in an acute care setting

Pharmacokinetic/pharmacodynamic parameters of vancomycin for predicting clinical outcome of enterococcal bacteremia

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