Are Vancomycin Trough Concentrations of 15 to 20 mg/L Associated With Increased Attainment of an AUC/MIC ≥ 400 in Patients With Presumed MRSA Infection?. (June 2017)

• Record Type: Journal Article
• Authors: Hale, Cory M.; Seabury, Robert W.; Steele, Jeffrey M.; Darko, William; Miller, Christopher D.
• Other Names: Millares-Sipin Catherine A. guest-editor.
• Is Part Of: Journal of pharmacy practice. Volume 30:Number 3(2017:Jun.)
• Page Start: 329
• Page End: 335
• Publication Date: 2017-06
• Subjects: vancomycin -- area under the curve (AUC) -- pharmacokinetic -- pharmacodynamic -- Staphylococcus aureus; Pharmacy -- Periodicals; Pharmacology -- Periodicals; 615.1
• DOI: 10.1177/0897190016642692
• Languages: English
• ISSNs: 0897-1900

Abstract

Purpose: To determine whether there is an association between higher vancomycin trough concentrations and attainment of a calculated area under the concentration–time curve (AUC)/minimum inhibitory concentration (MIC) ≥400. Methods: A retrospective analysis was conducted among vancomycin-treated adult patients with a positive methicillin-resistant Staphylococcus aureus (MRSA) culture. Attainment of a calculated AUC/MIC ≥400 was compared between patients with troughs in the reference range of 15 to 20 mg/L and those with troughs in the following ranges: <10, 10 to 14.9, and >20 mg/L. Nephrotoxicity was assessed as a secondary outcome based on corrected average vancomycin troughs over 10 days of treatment. Results: Overall, 226 patients were reviewed and 100 included. Relative to troughs ≥10, patients with vancomycin troughs <10 mg/L were 73% less likely to attain an AUC/MIC ≥400 (odds ratio [OR] 0.27, 95% confidence interval [CI]: 0.01-0.75). No difference was found in the attainment of an AUC/MIC ≥400 in patients with troughs of 10 to 14.9 mg/L and >20 mg/L when compared to patients with troughs of 15 to 20 mg/L. The mean corrected average vancomycin trough was higher in patients developing nephrotoxicity compared to those who did not (19.5 vs 14.5 mg/L, P < .001). Conclusion: Achieving vancomycin serum trough concentrations of 15 to 20 mg/L did not result in an increased attainment of the AUC/MIC target relative to troughs of 10 to 14.9 mg/L but may increase nephrotoxicity risk.