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. 2022 Aug 10;22(1):686.
doi: 10.1186/s12879-022-07668-w.

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

Eliel Nham  1 , Kyungmin Huh  2 , You Min Sohn  3 , Hyo Jung Park  3 , Hyemee Kim  4 , Sook Young Woo  5 , Jae-Hoon Ko  4 , Sun Young Cho  4 , Cheol-In Kang  4 , Doo Ryeon Chung  4 , Hee Jae Huh  6 , Hyung-Doo Park  6 , Nam Yong Lee  6 , Kyong Ran Peck  4
Affiliations

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

Eliel Nham et al. BMC Infect Dis. .

Abstract

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.

Keywords: AUC/MIC; Enterococcus; PK/PD; Trough; Vancomycin.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Distribution of 30-day mortality across vancomycin AUC24/MIC and trough concentrations. MIC, minimum inhibitory concentration; AUC24, area under the curve during 24 h
Fig. 2
Fig. 2
Receiver operating characteristic curve for the prediction of 30-day mortality by AUC24/MIC and trough concentration (black line: AUC24/MIC, blue line: trough concentration). MIC, minimum inhibitory concentration; AUC24, area under the curve during 24 h
See this image and copyright information in PMC

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