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

• Published in: BMC infectious diseases 2021-10, Vol.21 (1), p.1-1099, Article 1099
• Main Authors: Sohn, Yujin, Rim, John Hoon, Cho, Yunsuk, Hyun, Jonghoon, Baek, Yaejee, Kim, Moohyun, Kim, Jung Ho, Seong, Hye, Ahn, Jin Young, Lee, Sang-Guk, Lim, Jong-Beack, Jeong, Su Jin, Ku, Nam Su, Choi, Jun Yong, Yeom, Joon-Sup, Song, Young Goo
• Format: Article
• Language: English
• Subjects: Age; Antibiotics; AUC/MIC; Bacteremia; Bacteria; Bacterial diseases; Care and treatment; Creatinine; Diagnosis; Dosage and administration; Drug dosages; Drug resistance; Enterococcus; Gram-positive bacteria; Infections; Infectious diseases; Medical records; Methicillin; Methods; Minimum inhibitory concentration; Mortality; Multivariate analysis; Nosocomial infections; Patients; Peritonitis; Pharmacodynamics; Pharmacokinetics; Pharmacology; Prevention; Risk factors; Septic shock; Software; Staphylococcus aureus infections; Staphylococcus infections; Trough level; Urogenital system; Vancomycin
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-06809-x

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. 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. 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 ([less than or equai to] 15 [micro]g/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 ([less than or equai to] 15 [micro]g/mL; p = 0.041) and younger age (p = 0.031) were associated with 28-day mortality in patients with enterococcal bacteremia. In this study, a vancomycin trough level of 15 [micro]g/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.