Xiaoyu Liang1,2,3, Yaxing Fan1,2,3, Minjie Yang1, Jing Zhang1,2,3, Jufang Wu1, Jicheng Yu1, Jinhao Tao4, Guoping Lu4, Huifang Zhang5, Ruilan Wang5, Xiaoxing Wen6, Huayin Li6, Fengying Zhang7, Jingqin Hang7, Lihua Shen8, Zhongwei Zhang8, Qionghua Lin8, Fengming Fu8, Shengbin Wu9, Bo Shen9, Weifeng Huang10, Chunkang Chang11, Hong Zhang17, Qiwei Huang13, Yifan Shi14, Hong Ren14, Qing Yuan15, Xiaolian Song15, Xuming Luo16, Hong Zhang17. 1. Institute of Antibiotics, Huashan Hospital, Fudan University. 2. National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University. 3. Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People's Republic of China, Shanghai. 4. Department of Critical Care Medicine, Children's Hospital of Fudan University, Shanghai. 5. Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University. 6. Department of Respiration, Zhongshan Hospital, Fudan University, Shanghai. 7. Department of Respiration, Putuo People's Hospital, Tongji University. 8. Intensive Care Unit, Fudan University Shanghai Cancer Center. 9. Department of Nephrology, Shanghai Ninth People's Hospital. 10. Department of Critical Care Medicine, Shanghai Sixth People's Hospital, Shanghai Jiaotong University. 11. Department of Hematology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University. 12. Clinical Laboratory, Children's Hospital of Shanghai Jiaotong University. 13. Department of Neonatology, Children's Hospital of Shanghai Jiaotong University. 14. Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University. 15. Department of Respiration, Shanghai Tenth People's Hospital, Tongji University. 16. Department of Respiration, Putuo Hospital, Shanghai University of Traditional Chinese Medicine. 17. Department of Pharmacy, Tongji Hospital, Tongji University, Shanghai, People's Republic of China.
Abstract
Background: Vancomycin is a first-line antibiotic used for the treatment of severe gram-positive bacterial infections. Clinical guidelines recommend that the vancomycin trough concentration be 10-15 mg/L for regular infections and 15-20 mg/L for severe infections. We investigated whether increasing the vancomycin concentration would result in better clinical outcomes with sustainable adverse effects (AEs) in the Chinese population. Methods: A prospective, open, multicenter clinical observational study was performed in patients with gram-positive bacterial infections from 13 teaching hospitals. Patients received vancomycin therapeutic drug monitoring. Clinical, microbiological, and laboratory data were collected. Results: In total, 510 patients were enrolled, and 470 were evaluable, of whom 370 were adults and 100 were children; 35.53% had methicillin-resistant Staphylococcus aureus infections (vancomycin 50% minimum inhibitory concentration [MIC50] = 1, 90% minimum inhibitory concentration [MIC90] = 1), and 23.19% had Enterococcus species infections (vancomycin MIC50 = 1, MIC90 = 2). The average trough concentration was 10.54 ± 8.08 mg/L in adults and 6.74 ± 8.93 mg/L in children. The infection was eradicated in 86.22% of adults and 96% of children. Thirty-six vancomycin-related nephrotoxicity cases were reported in the enrolled population. No severe AEs or deaths were related to vancomycin therapy. Logistic regression analysis showed that trough concentration had no relationship with clinical outcomes (adults P = .75, children P = .68) but was correlated with adult nephrotoxicity (P < .0001). Vancomycin trough concentration had an applicable cut point at 13 mg/L. Conclusions: Our study shows that vancomycin trough concentration has no statistical correlation with clinical outcomes, and is an indicator of nephrotoxicity in the observed population. We found no evidence that increasing vancomycin trough concentration to 15-20 mg/L can benefit Chinese patients with complicated infections. Clinical Trials Registration: ChiCTR-OPC-16007920.
Background: Vancomycin is a first-line antibiotic used for the treatment of severe gram-positive bacterial infections. Clinical guidelines recommend that the vancomycin trough concentration be 10-15 mg/L for regular infections and 15-20 mg/L for severe infections. We investigated whether increasing the vancomycin concentration would result in better clinical outcomes with sustainable adverse effects (AEs) in the Chinese population. Methods: A prospective, open, multicenter clinical observational study was performed in patients with gram-positive bacterial infections from 13 teaching hospitals. Patients received vancomycin therapeutic drug monitoring. Clinical, microbiological, and laboratory data were collected. Results: In total, 510 patients were enrolled, and 470 were evaluable, of whom 370 were adults and 100 were children; 35.53% had methicillin-resistant Staphylococcus aureus infections (vancomycin 50% minimum inhibitory concentration [MIC50] = 1, 90% minimum inhibitory concentration [MIC90] = 1), and 23.19% had Enterococcus species infections (vancomycin MIC50 = 1, MIC90 = 2). The average trough concentration was 10.54 ± 8.08 mg/L in adults and 6.74 ± 8.93 mg/L in children. The infection was eradicated in 86.22% of adults and 96% of children. Thirty-six vancomycin-related nephrotoxicity cases were reported in the enrolled population. No severe AEs or deaths were related to vancomycin therapy. Logistic regression analysis showed that trough concentration had no relationship with clinical outcomes (adults P = .75, children P = .68) but was correlated with adult nephrotoxicity (P < .0001). Vancomycin trough concentration had an applicable cut point at 13 mg/L. Conclusions: Our study shows that vancomycin trough concentration has no statistical correlation with clinical outcomes, and is an indicator of nephrotoxicity in the observed population. We found no evidence that increasing vancomycin trough concentration to 15-20 mg/L can benefit Chinese patients with complicated infections. Clinical Trials Registration: ChiCTR-OPC-16007920.
Authors: Kevin J Downes; Molly Hayes; Julie C Fitzgerald; Gwendolyn M Pais; Jiajun Liu; Nicole R Zane; Stuart L Goldstein; Marc H Scheetz; Athena F Zuppa Journal: J Antimicrob Chemother Date: 2020-01-01 Impact factor: 5.790
Authors: Claudmeire Dias Carneiro de Almeida; Ana Cristina Simões E Silva; João Antonio de Queiroz Oliveira; Isabela Soares Fonseca Batista; Fernando Henrique Pereira; José Eduardo Gonçalves; Vandack Nobre; Maria Auxiliadora Parreiras Martins Journal: PLoS One Date: 2019-09-05 Impact factor: 3.240
Authors: Frederico Ribeiro Pires; Stefano Ivani de Paula; Artur Figueiredo Delgado; Werther Brunow de Carvalho; Nilo José Coelho Duarte; Ronaldo Morales Júnior; Silvia Regina Cavani Jorge Santos Journal: Rev Bras Ter Intensiva Date: 2020 Jul-Sep