Vancomycin Area Under the Curve–Guided Dosing and Monitoring for Adult and Pediatric Patients With Suspected or Documented Serious Methicillin-Resistant <i>Staphylococcus aureus</i> Infections: Putting the Safety of Our Patients First

Lodise, Thomas P.; Drusano, George L.

doi:10.1093/cid/ciaa1744

Cited by 31 publications

(18 citation statements)

References 27 publications

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“…A recent meta-analysis of CT studies also suggested that there is no difference in AKI between CT and MT, and notably most of the included studies had a cephalosporin-based BL [ 16 ]. Second, VAN AUC-guided dosing, which is associated with lower AKI, was implemented at the DMC in 2015 and is consequently more prevalent in POST compared with PRE [ 32 , 33 ]. Third, our institution switched from piperacillin/tazobactam to cefepime as the primary empiric gram-negative agent of choice in 2015.…”

Section: Discussionmentioning

confidence: 99%

Standardized Treatment and Assessment Pathway Improves Mortality in Adults With Methicillin-resistant Staphylococcus aureus Bacteremia: STAPH Study

Alosaimy

Lagnf

Morrisette

et al. 2021

Open Forum Infectious Diseases

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Background Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) management remains challenging for clinicians. Numerous in vitro studies report synergy when vancomycin (VAN)/daptomycin (DAP) were combined with beta-lactams (BL), which has led to clinical implementation of these combinations. While shorter durations of bacteremia have often been reported, there has been no significant impact on mortality. Methods The Detroit Medical Center (DMC) developed and implemented a clinical pathway algorithm for MRSA BSI treatment in 2016 that included the early use of BL combination therapy with standard-of-care (VAN or DAP) and a mandatory infectious diseases consultation. This was a retrospective, quasi-experimental study at the DMC between 2013-2020. Multivariable logistic regression was used to assess the independent association between pathway implementation and 30-day mortality while adjusting for confounding variables. Results Overall, 813 adult patients treated for MRSA BSI were evaluated. Compared to pre-pathway (PRE) patients (n=379), those treated post-pathway (POST) (n=434) had a significant reduction in 30-day and 90-day mortality; 9.7% in POST vs. 15.6% in PRE (p=0.011) and 12.2% in POST vs. 19.0% in PRE (p=0.007), respectively. The incidence of acute kidney injury (AKI) was higher in the PRE compared to POST; 9.6% vs. 7.2% (p=0.282), respectively. After adjusting for confounding variables including infectious diseases consult, POST was independently associated with a reduction in 30-day mortality (adjusted odds ratio [aOR], 0.608; 95% confidence interval [CI], 0.375-0.986). Conclusions Implementation of a MRSA BSI treatment pathway with early use of BL reduced mortality with no increased in AKI. Further prospective evaluation of this pathway approach is warranted.

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Section: Discussionmentioning

confidence: 99%

Standardized Treatment and Assessment Pathway Improves Mortality in Adults With Methicillin-resistant Staphylococcus aureus Bacteremia: STAPH Study

Alosaimy

Lagnf

Morrisette

et al. 2021

Open Forum Infectious Diseases

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“…Nevertheless, the easiest and safest way to achieve this PK target is the use of continuous infusions [ 220 ], with most data suggesting equivalence in outcomes with intermittent dosing [ 84 ]. This dosing strategy may also help to prevent nephrotoxicity [ 221 ] and decrease the emergence of resistant bacteria [ 75 ].…”

Section: Impact Of Dosing Strategies On Outcomesmentioning

confidence: 99%

Optimizing Antimicrobial Drug Dosing in Critically Ill Patients

et al. 2021

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A fundamental step in the successful management of sepsis and septic shock is early empiric antimicrobial therapy. However, for this to be effective, several decisions must be addressed simultaneously: (1) antimicrobial choices should be adequate, covering the most probable pathogens; (2) they should be administered in the appropriate dose, (3) by the correct route, and (4) using the correct mode of administration to achieve successful concentration at the infection site. In critically ill patients, antimicrobial dosing is a common challenge and a frequent source of errors, since these patients present deranged pharmacokinetics, namely increased volume of distribution and altered drug clearance, which either increased or decreased. Moreover, the clinical condition of these patients changes markedly over time, either improving or deteriorating. The consequent impact on drug pharmacokinetics further complicates the selection of correct drug schedules and dosing during the course of therapy. In recent years, the knowledge of pharmacokinetics and pharmacodynamics, drug dosing, therapeutic drug monitoring, and antimicrobial resistance in the critically ill patients has greatly improved, fostering strategies to optimize therapeutic efficacy and to reduce toxicity and adverse events. Nonetheless, delivering adequate and appropriate antimicrobial therapy is still a challenge, since pathogen resistance continues to rise, and new therapeutic agents remain scarce. We aim to review the available literature to assess the challenges, impact, and tools to optimize individualization of antimicrobial dosing to maximize exposure and effectiveness in critically ill patients.

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“…The levels can be used to calculate an elimination rate constant (Ke) and an apparent volume of distribution (Vd), which together equal vancomycin clearance (CLv). Equation (1).…”

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

“…When taken at face value, vancomycin troughs are poor surrogates of the area under the curve (AUC) 1 . The revised vancomycin monitoring guidelines recommend targeting an AUC range of 400–600 mg*hr/L for serious methicillin‐resistant Staphylococcus aureus (MRSA) infections 2 …”

Section: What Is Known and Objectivementioning

confidence: 99%

“…When taken at face value, vancomycin troughs are poor surrogates of the area under the curve (AUC). 1 The revised vancomycin monitoring guidelines recommend targeting an AUC range of 400–600 mg*hr/L for serious methicillin‐resistant Staphylococcus aureus (MRSA) infections. 2 With a vancomycin minimum inhibitory concentration (MIC) of 1 mg/L, a daily AUC ≥400 is needed for efficacy while a daily AUC >650 may increase the risk of acute kidney injury.…”

Section: What Is Known and Objectivementioning

confidence: 99%

See 1 more Smart Citation

Vancomycin area under the curves estimated with pharmacokinetic equations using trough‐only data

Fewel¹

2021

J Clin Pharm Ther

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Vancomycin Area Under the Curve–Guided Dosing and Monitoring for Adult and Pediatric Patients With Suspected or Documented Serious Methicillin-Resistant Staphylococcus aureus Infections: Putting the Safety of Our Patients First

Cited by 31 publications

References 27 publications

Standardized Treatment and Assessment Pathway Improves Mortality in Adults With Methicillin-resistant Staphylococcus aureus Bacteremia: STAPH Study

Standardized Treatment and Assessment Pathway Improves Mortality in Adults With Methicillin-resistant Staphylococcus aureus Bacteremia: STAPH Study

Optimizing Antimicrobial Drug Dosing in Critically Ill Patients

Vancomycin area under the curves estimated with pharmacokinetic equations using trough‐only data

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