Vancomycin AUC/MIC ratio and 30-day mortality in patients with Staphylococcus aureus bacteremia

Holmes, Natasha E., Turnidge, John D., Munckhof, Wendy J., Robinson, J. Owen, Korman, Tony M., O'Sullivan, Matthew V. N., Anderson, Tara L., Roberts, Sally A., Warren, Sanchia J. C., Gao, Wei, Howden, Benjamin P. and Johnson, Paul D. R. (2013) Vancomycin AUC/MIC ratio and 30-day mortality in patients with Staphylococcus aureus bacteremia. Antimicrobial Agents and Chemotherapy, 57 4: 1654-1663. doi:10.1128/AAC.01485-12

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Author Holmes, Natasha E.
Turnidge, John D.
Munckhof, Wendy J.
Robinson, J. Owen
Korman, Tony M.
O'Sullivan, Matthew V. N.
Anderson, Tara L.
Roberts, Sally A.
Warren, Sanchia J. C.
Gao, Wei
Howden, Benjamin P.
Johnson, Paul D. R.
Title Vancomycin AUC/MIC ratio and 30-day mortality in patients with Staphylococcus aureus bacteremia
Journal name Antimicrobial Agents and Chemotherapy   Check publisher's open access policy
ISSN 0066-4804
1098-6596
Publication date 2013-04
Year available 2013
Sub-type Article (original research)
DOI 10.1128/AAC.01485-12
Open Access Status File (Publisher version)
Volume 57
Issue 4
Start page 1654
End page 1663
Total pages 10
Place of publication Washington, United States
Publisher American Society for Microbiology
Collection year 2014
Language eng
Formatted abstract
A ratio of the vancomycin area under the concentration-time curve to the MIC (AUC/MIC) of ≥400 has been associated with clinical success when treating Staphylococcus aureus pneumonia, and this target was recommended by recently published vancomycin therapeutic monitoring consensus guidelines for treating all serious S. aureus infections. Here, vancomycin serum trough levels and vancomycin AUC/MIC were evaluated in a “real-world” context by following a cohort of 182 patients with S. aureus bacteremia (SAB) and analyzing these parameters within the critical first 96 h of vancomycin therapy. The median vancomycin trough level at this time point was 19.5 mg/liter. There was a significant difference in vancomycin AUC/MIC when using broth microdilution (BMD) compared with Etest MIC (medians of 436.1 and 271.5, respectively; P < 0.001). Obtaining the recommended vancomycin target AUC/MIC of ≥400 using BMD was not associated with lower 30-day all-cause or attributable mortality from SAB (P = 0.132 and P = 0.273, respectively). However, an alternative vancomycin AUC/MIC of >373, derived using classification and regression tree analysis, was associated with reduced mortality (P = 0.043) and remained significant in a multivariable model. This study demonstrated that we obtained vancomycin trough levels in the target therapeutic range early during the course of therapy and that obtaining a higher vancomycin AUC/MIC (in this case, >373) within 96 h was associated with reduced mortality. The MIC test method has a significant impact on vancomycin AUC/MIC estimation. Clinicians should be aware that the current target AUC/MIC of ≥400 was derived using the reference BMD method, so adjustments to this target need to be made when calculating AUC/MIC ratio using other MIC testing methods
Keyword Minimum inhibitory concentration
Glomerular filtration rate
Chronic kidney disease
Bactericidal activity
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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