Abstract
The objective of this study was to evaluate the relationship between vancomycin trough levels in patients with documented enterococcal infections and mortality, clinical outcomes, microbiological outcomes, and nephrotoxicity. We conducted a retrospective cohort study of patients with enterococcus infections who were prescribed vancomycin with therapeutic drug monitoring during January 2010 and December 2019 at Chiang Mai University Hospital (CMUH). The study enrolled 300 participants who met the inclusion criteria and were prescribed vancomycin with therapeutic drug monitoring. The results of this study showed that, after propensity score matching, a vancomycin trough of ≥15 mg/L was associated with significant differences in 30-days mortality compared to a vancomycin trough of <15 mg/L (aHR: 0.41, 95% CI: 0.21–0.82; p = 0.011). Likewise, a vancomycin trough of ≥15 mg/L was associated with significant differences in the clinical response (aHR: 0.49, 95% CI: 0.26–0.94; p = 0.032), microbiological response (aHR: 0.32, 95% CI: 0.12–0.87; p = 0.025) and nephrotoxicity (aHR: 3.17, 95% CI: 1.39–7.23; p = 0.006), compared with a vancomycin trough of <15 mg/L. However, sub-group analysis found that very high trough levels (>20 mg/L) were also associated with a high rate of nephrotoxicity (aHR: 3.55, 95% CI 1.57–8.07, p = 0.002), when compared with a vancomycin trough of <15 mg/L. The target vancomycin trough concentration was ≥15 mg/L and this target can be an optimal alternative to the use of area under the curve (AUC) values for monitoring the treatment of enterococcal infection.
Highlights
Enterococci spp., especially Enterococcus faecium and Enterococcus feacalis are Gram positive, facultative anaerobe, oval, cocci bacteria, which form chains of varying lengths (Schröder et al, 2015)
Vancomycin trough concentrations of ≥15 mg/L substantially increase the risk of nephrotoxicity compared to vancomycin trough concentrations
Vancomycin trough concentrations of ≥15 mg/L significantly decreased 30-days mortality, clinical failure, and microbiological failure
Summary
Enterococci spp., especially Enterococcus faecium and Enterococcus feacalis are Gram positive, facultative anaerobe, oval, cocci bacteria, which form chains of varying lengths (Schröder et al, 2015). They are present naturally in gastrointestinal system colonisers, but can cause a number of infections, including pelvic infections, endocarditis, wound infections, and urinary tract infections (UTIs). In clinical practice found that troughdirected dosing is a more realistic alternative to AUC/MICguided dosing (Deryke and Alexander, 2009; Matsumoto et al, 2013)
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