Vancomycin serum trough concentration vs. clinical outcome in patients with gram-positive infection: a retrospective analysis

Abstract

This retrospective analysis failed to demonstrate an association between vancomycin trough concentration and the clinical and microbiological response. Prospective controlled studies are necessary to further establish the need for the higher trough concentrations normally cited for clinical efficacy.

Retrospective analysis of vancomycin treatment outcomes in Chinese paediatric patients with suspected Gram-positive infection

“…Consistent with their finding, 71·4% (130/182) of our paediatric patients experienced treatment success with vancomycin. In our study, the incidence of nephrotoxicity was 2·4% (4/165) in children receiving at least 72 h of vancomycin therapy, which is lower than previously reported . Using a similar definition for nephrotoxicity, McKamy et al .…”

“…found that higher vancomycin trough levels did not result in an improved clinical response but likely increased the incidence of nephrotoxicity. A recent study of Chinese adults with Gram‐positive infection did not find any association between the vancomycin trough concentration and the clinical and microbiological responses . In addition, several meta‐analyses have shown that higher vancomycin trough levels (15 mg/L or greater) were not associated with significantly reduced treatment failure, persistent bacteraemia or mortality .…”

“…Cao et al . reported that the improvement rate of clinical signs and symptoms in Chinese adult patients receiving vancomycin therapy was 76·4% (113/148).…”

“…Treatment outcomes were classified as success or failure based on information documented in medical records. Treatment success was defined as the resolution of infection‐related clinical signs and symptoms based on laboratory tests and medical images, microbiological eradication, and no additional use of anti‐Gram‐positive antibiotics . Treatment failure was defined as an inadequate response to initial therapy, persistence or progression of clinical signs and symptoms of infection at the end of vancomycin therapy, recurrence of Gram‐positive bacterium within 30 days after the end of vancomycin therapy, or treatment‐limiting adverse events or death before the resolution of signs or symptoms of infection.…”

“…It has been reported that vancomycin treatment failure rates range from 26·3% to 64·4% . Previous literature has identified independent predictors of treatment failure including the AUC/MIC, MIC, vancomycin serum trough concentration, demographic factors and health conditions (e.g.…”