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Article

Is Early Monitoring Better? Impact of Early Vancomycin Exposure on Treatment Outcomes and Nephrotoxicity in Patients with Methicillin-Resistant Staphylococcus aureus Infections

1
College of Pharmacotherapy Thailand, Nontaburi 11000, Thailand
2
Department of Pharmacy Practice, Faculty of Pharmacy, Payap University, Chiang Mai 50000, Thailand
3
Division of Infectious Disease, Department of Medicine, Phramongkutklao Hospital, Bangkok 10400, Thailand
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Department of Pharmaceutical Care Faculty of Pharmacy Chiang Mai University, Chiang Mai 50200, Thailand
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Faculty of Medical Technology, Nakhonratchasima College, Nakhon Ratchasima 30000, Thailand
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Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakorn Pathom 73000, Thailand
7
Pharmaceutical Initiative for Resistant Bacteria and Infectious Disease Working Group [PIRBIG], Nakorn Pathom 73000, Thailand
*
Author to whom correspondence should be addressed.
Antibiotics 2020, 9(10), 672; https://doi.org/10.3390/antibiotics9100672
Received: 11 August 2020 / Revised: 29 September 2020 / Accepted: 1 October 2020 / Published: 4 October 2020
(This article belongs to the Section Pharmacokinetics and Pharmacodynamics of Drugs)
Optimal early vancomycin target exposure remains controversial. To clarify the therapeutic exposure range, we investigated the association between vancomycin exposure and treatment outcomes or nephrotoxicity in patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. This retrospective study reviewed clinical data obtained from 131 patients with MRSA infections between January 2017 and September 2019. Clinical outcomes included treatment failure, 30-day mortality, microbiological failure, and acute kidney injury. We measured serum vancomycin levels after the first dose to 48 h and estimated vancomycin exposure using the Bayesian theorem. The minimum inhibitory concentration (MIC) of antimicrobial agents was determined using the broth microdilution method. Classification and Regression Tree analyses identified day 1 and 2 exposure thresholds associated with an increased risk of failure and nephrotoxicity. Treatment failure (27.9% vs. 33.3%) and 30-day mortality (26.6% vs. 31.74%) were numerically but not significantly reduced in patients with the area under the curve (AUC)24–48h/MICBMD ≥ 698. Patients with AUCss/MICBMD ≥ 679 exhibited a significantly increased risk of acute kidney injury (27.9% vs. 10.9%, p = 0.041). These findings indicate that AUCss/MICBMD ratios > 600 may cause nephrotoxicity. AUC/MICBMD at days 1 and 2 do not appear to be significantly associated with particular clinical outcomes, but further studies are needed. View Full-Text
Keywords: area under the curve; mortality; MRSA; nephrotoxicity; vancomycin area under the curve; mortality; MRSA; nephrotoxicity; vancomycin
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MDPI and ACS Style

Chattaweelarp, T.; Changpradub, D.; Punyawudho, B.; Thunyaharn, S.; Santimaleeworagun, W. Is Early Monitoring Better? Impact of Early Vancomycin Exposure on Treatment Outcomes and Nephrotoxicity in Patients with Methicillin-Resistant Staphylococcus aureus Infections. Antibiotics 2020, 9, 672. https://doi.org/10.3390/antibiotics9100672

AMA Style

Chattaweelarp T, Changpradub D, Punyawudho B, Thunyaharn S, Santimaleeworagun W. Is Early Monitoring Better? Impact of Early Vancomycin Exposure on Treatment Outcomes and Nephrotoxicity in Patients with Methicillin-Resistant Staphylococcus aureus Infections. Antibiotics. 2020; 9(10):672. https://doi.org/10.3390/antibiotics9100672

Chicago/Turabian Style

Chattaweelarp, Thanawat, Dhitiwat Changpradub, Baralee Punyawudho, Sudaluck Thunyaharn, and Wichai Santimaleeworagun. 2020. "Is Early Monitoring Better? Impact of Early Vancomycin Exposure on Treatment Outcomes and Nephrotoxicity in Patients with Methicillin-Resistant Staphylococcus aureus Infections" Antibiotics 9, no. 10: 672. https://doi.org/10.3390/antibiotics9100672

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