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Attention to age: similar dosing regimens lead to different vancomycin levels among older and younger patients
Abstract Background little is known on the clinical implications of vancomycin trough levels among older patients. Objective to evaluate the association between vancomycin levels and outcomes among older versus younger patients. Design retrospective study. Subjects patients aged 18–64 and ≥65 years...
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| Published in: | Age and ageing 2020-01, Vol.49 (1), p.26-31 |
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| container_title | Age and ageing |
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| creator | Yahav, Dafna Abbas, Maria Nassar, Laila Ghrayeb, Alia Shepshelovich, Daniel Kurnik, Daniel Leibovici, Leonard Paul, Mical |
| description | Abstract
Background
little is known on the clinical implications of vancomycin trough levels among older patients.
Objective
to evaluate the association between vancomycin levels and outcomes among older versus younger patients.
Design
retrospective study.
Subjects
patients aged 18–64 and ≥65 years treated with vancomycin for documented methicillin resistant Staphylococcus aureus (MRSA) infections.
Methods
we compared the effectiveness and toxicity of vancomycin according to trough levels in older versus younger patients. Subgroup analysis of patients with glomerular filtration rate (GFR) > 60 ml/min/1.73 m2 was performed.
Results
we included 181 patients aged ≥65 years and 104 younger patients. Mean age in the older group was 76.9 ± 8 years versus 50.9 ± 12.4 in the younger group. Vancomycin trough levels and 24-hours area under the curve to minimal inhibitory concentrations (AUC/MIC) were significantly higher in older patients who were also significantly more likely to achieve trough levels of ≥15 mg/l within 4 days, (98/181 (54.1%) vs. 38/104 (36.5%) in younger patients, P = 0.004). Results were similar among patients with GFR > 60. Thirty-day mortality was significantly higher in older (74/181, 40.9% vs. 13/104, 12.5%, respectively, P |
| doi_str_mv | 10.1093/ageing/afz135 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2431014308</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ageing/afz135</oup_id><sourcerecordid>2431014308</sourcerecordid><originalsourceid>FETCH-LOGICAL-c393t-3e086554b6b35d624e5e6e175f1ec61fbc2e680814dd783ff8749435f097fed33</originalsourceid><addsrcrecordid>eNqFkM1LwzAYh4Mobk6PXiXgxUtd0iT98DaGXzDwoueSNm9KRpvMpB3Mv96MqldPecP7_J6QH0LXlNxTUrKlbMHYdin1F2XiBM0pz4okLRg_RXNCSJqQPC1n6CKEbbxSQdNzNGM0p5QSOkd2NQxgB-MsHhyOsgccTG866bFyIZqxh9b0YAPuQKojpIzW4GMI76VtXH9ojI3LPXQBy97FiOsUeCytwgc32jbOOzmYmAiX6EzLLsDVz7lAH0-P7-uXZPP2_LpebZKGlWxIGJAiE4LXWc2EylIOAjKgudAUmozqukkhK0hBuVJ5wbQucl5yJjQpcw2KsQW6nbw77z5HCEO1daO38ckq5Sz-nDNSRCqZqMa7EDzoaudNL_2hoqQ6tltN7VZTu5G_-bGOdQ_qj_6tMwJ3E-DG3T-ub5ZwhjA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2431014308</pqid></control><display><type>article</type><title>Attention to age: similar dosing regimens lead to different vancomycin levels among older and younger patients</title><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>Oxford Journals Online</source><creator>Yahav, Dafna ; Abbas, Maria ; Nassar, Laila ; Ghrayeb, Alia ; Shepshelovich, Daniel ; Kurnik, Daniel ; Leibovici, Leonard ; Paul, Mical</creator><creatorcontrib>Yahav, Dafna ; Abbas, Maria ; Nassar, Laila ; Ghrayeb, Alia ; Shepshelovich, Daniel ; Kurnik, Daniel ; Leibovici, Leonard ; Paul, Mical</creatorcontrib><description>Abstract
Background
little is known on the clinical implications of vancomycin trough levels among older patients.
Objective
to evaluate the association between vancomycin levels and outcomes among older versus younger patients.
Design
retrospective study.
Subjects
patients aged 18–64 and ≥65 years treated with vancomycin for documented methicillin resistant Staphylococcus aureus (MRSA) infections.
Methods
we compared the effectiveness and toxicity of vancomycin according to trough levels in older versus younger patients. Subgroup analysis of patients with glomerular filtration rate (GFR) > 60 ml/min/1.73 m2 was performed.
Results
we included 181 patients aged ≥65 years and 104 younger patients. Mean age in the older group was 76.9 ± 8 years versus 50.9 ± 12.4 in the younger group. Vancomycin trough levels and 24-hours area under the curve to minimal inhibitory concentrations (AUC/MIC) were significantly higher in older patients who were also significantly more likely to achieve trough levels of ≥15 mg/l within 4 days, (98/181 (54.1%) vs. 38/104 (36.5%) in younger patients, P = 0.004). Results were similar among patients with GFR > 60. Thirty-day mortality was significantly higher in older (74/181, 40.9% vs. 13/104, 12.5%, respectively, P < 0.001). There was no association between vancomycin trough levels and mortality among older patients. No significant differences were demonstrated in clinical or microbiological success or nephrotoxicity.
Conclusions
applying uniform dosing recommendations across age groups among adults with MRSA infections results in higher vancomycin levels and AUC/MIC in older versus younger patients. Yet, mortality rates remain higher among older adults. Prospective studies are needed to define the optimal approach for using this drug in older patients.</description><identifier>ISSN: 0002-0729</identifier><identifier>EISSN: 1468-2834</identifier><identifier>DOI: 10.1093/ageing/afz135</identifier><identifier>PMID: 31711101</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Age differences ; Antibiotics ; Dosage ; Drug resistance ; Glomerular filtration rate ; Infections ; Methicillin ; Minimum inhibitory concentration ; Mortality ; Mortality rates ; MRSA ; Older people ; Prospective studies ; Staphylococcus aureus ; Staphylococcus infections ; Toxicity ; Vancomycin</subject><ispartof>Age and ageing, 2020-01, Vol.49 (1), p.26-31</ispartof><rights>The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com 2019</rights><rights>The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><rights>The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-3e086554b6b35d624e5e6e175f1ec61fbc2e680814dd783ff8749435f097fed33</citedby><cites>FETCH-LOGICAL-c393t-3e086554b6b35d624e5e6e175f1ec61fbc2e680814dd783ff8749435f097fed33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925,30999</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31711101$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yahav, Dafna</creatorcontrib><creatorcontrib>Abbas, Maria</creatorcontrib><creatorcontrib>Nassar, Laila</creatorcontrib><creatorcontrib>Ghrayeb, Alia</creatorcontrib><creatorcontrib>Shepshelovich, Daniel</creatorcontrib><creatorcontrib>Kurnik, Daniel</creatorcontrib><creatorcontrib>Leibovici, Leonard</creatorcontrib><creatorcontrib>Paul, Mical</creatorcontrib><title>Attention to age: similar dosing regimens lead to different vancomycin levels among older and younger patients</title><title>Age and ageing</title><addtitle>Age Ageing</addtitle><description>Abstract
Background
little is known on the clinical implications of vancomycin trough levels among older patients.
Objective
to evaluate the association between vancomycin levels and outcomes among older versus younger patients.
Design
retrospective study.
Subjects
patients aged 18–64 and ≥65 years treated with vancomycin for documented methicillin resistant Staphylococcus aureus (MRSA) infections.
Methods
we compared the effectiveness and toxicity of vancomycin according to trough levels in older versus younger patients. Subgroup analysis of patients with glomerular filtration rate (GFR) > 60 ml/min/1.73 m2 was performed.
Results
we included 181 patients aged ≥65 years and 104 younger patients. Mean age in the older group was 76.9 ± 8 years versus 50.9 ± 12.4 in the younger group. Vancomycin trough levels and 24-hours area under the curve to minimal inhibitory concentrations (AUC/MIC) were significantly higher in older patients who were also significantly more likely to achieve trough levels of ≥15 mg/l within 4 days, (98/181 (54.1%) vs. 38/104 (36.5%) in younger patients, P = 0.004). Results were similar among patients with GFR > 60. Thirty-day mortality was significantly higher in older (74/181, 40.9% vs. 13/104, 12.5%, respectively, P < 0.001). There was no association between vancomycin trough levels and mortality among older patients. No significant differences were demonstrated in clinical or microbiological success or nephrotoxicity.
Conclusions
applying uniform dosing recommendations across age groups among adults with MRSA infections results in higher vancomycin levels and AUC/MIC in older versus younger patients. Yet, mortality rates remain higher among older adults. Prospective studies are needed to define the optimal approach for using this drug in older patients.</description><subject>Age differences</subject><subject>Antibiotics</subject><subject>Dosage</subject><subject>Drug resistance</subject><subject>Glomerular filtration rate</subject><subject>Infections</subject><subject>Methicillin</subject><subject>Minimum inhibitory concentration</subject><subject>Mortality</subject><subject>Mortality rates</subject><subject>MRSA</subject><subject>Older people</subject><subject>Prospective studies</subject><subject>Staphylococcus aureus</subject><subject>Staphylococcus infections</subject><subject>Toxicity</subject><subject>Vancomycin</subject><issn>0002-0729</issn><issn>1468-2834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNqFkM1LwzAYh4Mobk6PXiXgxUtd0iT98DaGXzDwoueSNm9KRpvMpB3Mv96MqldPecP7_J6QH0LXlNxTUrKlbMHYdin1F2XiBM0pz4okLRg_RXNCSJqQPC1n6CKEbbxSQdNzNGM0p5QSOkd2NQxgB-MsHhyOsgccTG866bFyIZqxh9b0YAPuQKojpIzW4GMI76VtXH9ojI3LPXQBy97FiOsUeCytwgc32jbOOzmYmAiX6EzLLsDVz7lAH0-P7-uXZPP2_LpebZKGlWxIGJAiE4LXWc2EylIOAjKgudAUmozqukkhK0hBuVJ5wbQucl5yJjQpcw2KsQW6nbw77z5HCEO1daO38ckq5Sz-nDNSRCqZqMa7EDzoaudNL_2hoqQ6tltN7VZTu5G_-bGOdQ_qj_6tMwJ3E-DG3T-ub5ZwhjA</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Yahav, Dafna</creator><creator>Abbas, Maria</creator><creator>Nassar, Laila</creator><creator>Ghrayeb, Alia</creator><creator>Shepshelovich, Daniel</creator><creator>Kurnik, Daniel</creator><creator>Leibovici, Leonard</creator><creator>Paul, Mical</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>20200101</creationdate><title>Attention to age: similar dosing regimens lead to different vancomycin levels among older and younger patients</title><author>Yahav, Dafna ; Abbas, Maria ; Nassar, Laila ; Ghrayeb, Alia ; Shepshelovich, Daniel ; Kurnik, Daniel ; Leibovici, Leonard ; Paul, Mical</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-3e086554b6b35d624e5e6e175f1ec61fbc2e680814dd783ff8749435f097fed33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age differences</topic><topic>Antibiotics</topic><topic>Dosage</topic><topic>Drug resistance</topic><topic>Glomerular filtration rate</topic><topic>Infections</topic><topic>Methicillin</topic><topic>Minimum inhibitory concentration</topic><topic>Mortality</topic><topic>Mortality rates</topic><topic>MRSA</topic><topic>Older people</topic><topic>Prospective studies</topic><topic>Staphylococcus aureus</topic><topic>Staphylococcus infections</topic><topic>Toxicity</topic><topic>Vancomycin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yahav, Dafna</creatorcontrib><creatorcontrib>Abbas, Maria</creatorcontrib><creatorcontrib>Nassar, Laila</creatorcontrib><creatorcontrib>Ghrayeb, Alia</creatorcontrib><creatorcontrib>Shepshelovich, Daniel</creatorcontrib><creatorcontrib>Kurnik, Daniel</creatorcontrib><creatorcontrib>Leibovici, Leonard</creatorcontrib><creatorcontrib>Paul, Mical</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Age and ageing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yahav, Dafna</au><au>Abbas, Maria</au><au>Nassar, Laila</au><au>Ghrayeb, Alia</au><au>Shepshelovich, Daniel</au><au>Kurnik, Daniel</au><au>Leibovici, Leonard</au><au>Paul, Mical</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Attention to age: similar dosing regimens lead to different vancomycin levels among older and younger patients</atitle><jtitle>Age and ageing</jtitle><addtitle>Age Ageing</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>49</volume><issue>1</issue><spage>26</spage><epage>31</epage><pages>26-31</pages><issn>0002-0729</issn><eissn>1468-2834</eissn><abstract>Abstract
Background
little is known on the clinical implications of vancomycin trough levels among older patients.
Objective
to evaluate the association between vancomycin levels and outcomes among older versus younger patients.
Design
retrospective study.
Subjects
patients aged 18–64 and ≥65 years treated with vancomycin for documented methicillin resistant Staphylococcus aureus (MRSA) infections.
Methods
we compared the effectiveness and toxicity of vancomycin according to trough levels in older versus younger patients. Subgroup analysis of patients with glomerular filtration rate (GFR) > 60 ml/min/1.73 m2 was performed.
Results
we included 181 patients aged ≥65 years and 104 younger patients. Mean age in the older group was 76.9 ± 8 years versus 50.9 ± 12.4 in the younger group. Vancomycin trough levels and 24-hours area under the curve to minimal inhibitory concentrations (AUC/MIC) were significantly higher in older patients who were also significantly more likely to achieve trough levels of ≥15 mg/l within 4 days, (98/181 (54.1%) vs. 38/104 (36.5%) in younger patients, P = 0.004). Results were similar among patients with GFR > 60. Thirty-day mortality was significantly higher in older (74/181, 40.9% vs. 13/104, 12.5%, respectively, P < 0.001). There was no association between vancomycin trough levels and mortality among older patients. No significant differences were demonstrated in clinical or microbiological success or nephrotoxicity.
Conclusions
applying uniform dosing recommendations across age groups among adults with MRSA infections results in higher vancomycin levels and AUC/MIC in older versus younger patients. Yet, mortality rates remain higher among older adults. Prospective studies are needed to define the optimal approach for using this drug in older patients.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>31711101</pmid><doi>10.1093/ageing/afz135</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Age and ageing, 2020-01, Vol.49 (1), p.26-31 |
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| language | eng |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); Oxford Journals Online |
| subjects | Age differences Antibiotics Dosage Drug resistance Glomerular filtration rate Infections Methicillin Minimum inhibitory concentration Mortality Mortality rates MRSA Older people Prospective studies Staphylococcus aureus Staphylococcus infections Toxicity Vancomycin |
| title | Attention to age: similar dosing regimens lead to different vancomycin levels among older and younger patients |
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