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- Title
Association Between Vancomycin AUC and Clinical Failure in Patients with Streptococcal Bacteremia.
- Authors
Aycock, Anna; Smith, Jessica M.; Coe, Kelci; Wang, Shu-Hua; Reed, Erica
- Abstract
Background: Monitoring of vancomycin using the area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio is now preferred for serious methicillin-resistant Staphylococcus aureus infections. Vancomycin AUC/MIC monitoring is being investigated but is not yet well elucidated with other bacterial pathogens. Methods: A retrospective cross-sectional study was conducted assessing patients with streptococcal bacteremia treated with vancomycin definitive therapy. AUC was calculated using a Bayesian approach, and classification and regression tree analysis was used to identify a vancomycin AUC threshold predictive of clinical failure. Results: Eleven patients had a vancomycin AUC < 329 of which 8 (73%) experienced clinical failure, while 35 patients had a vancomycin AUC ≥ 329 of which 12 (34%) experienced clinical failure (P =.04). Hospital length of stay was longer in the AUC ≥ 329 group (15 vs 8 days, P =.05), whereas time to bacteremia clearance (29 [22-45] vs 25 [20-29] hours, P =.15) and toxicity incidence (13% vs 4%, P = 1) were similar between groups. Conclusions: This study identified a VAN AUC threshold of <329 to be predictive of clinical failure in patients with streptococcal bacteremia which should be interpreted as hypothesis-generating. Studies evaluating VAN AUC-based monitoring for streptococcal bloodstream infections along with other infection types are needed before implementation into clinical practice can be recommended.
- Subjects
BACTEREMIA; LENGTH of stay in hospitals; CROSS-sectional method; STREPTOCOCCAL diseases; VANCOMYCIN; RETROSPECTIVE studies; MANN Whitney U Test; FISHER exact test; TREATMENT failure; T-test (Statistics); DRUG monitoring; DESCRIPTIVE statistics; CHI-squared test; RESEARCH funding; DATA analysis software; DRUG toxicity
- Publication
Hospital Pharmacy, 2023, Vol 58, Issue 3, p289
- ISSN
0018-5787
- Publication type
Article
- DOI
10.1177/00185787221139424