Vancomycin in vitro bactericidal activity and its relationship to efficacy in clearance of methicillin-resistant Staphylococcus aureus bacteremia
Vancomycin in vitro bactericidal activity and its relationship to efficacy in clearance of methicillin-resistant Staphylococcus aureus bacteremia
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DOI：
10.1128/aac.00939-06
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发表时间：
2007-07-01
影响因子：
4.9
通讯作者：
Schentag, Jerome J.
中科院分区：
文献类型：
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作者：
Moise, Pamela A.;Sakoulas, George;Schentag, Jerome J.
我们研究了患者接受万古霉素治疗时耐甲氧西林金黄色葡萄球菌（MRSA）菌血症清除时间与万古霉素体外杀菌活性之间的关系。对来自34例不同MRSA菌血症患者的34株MRSA血流分离株（17株辅助基因调节子组II [agr-II]和17株非agr-II分离株）进行万古霉素杀灭试验，这些患者的临床和微生物学结局数据可用。前瞻性调整万古霉素剂量，使血浆峰浓度为28 - 32 μ g/ml，谷浓度为8 - 12 μ g/ml。在含有16 μ g/ml万古霉素的肉汤中，以类似于10（7）至10（8）CFU/ml的浓度进行杀菌试验24 h。MRSA分离株患者在24 h时标志CFU/ml减少>= 2.5的菌血症清除中位时间为6.5天，MRSA分离株患者在24 h时标志CFU/ml减少< 2.5 log（10）CFU/ml的菌血症清除中位时间为> 10.5天（P = 0.025）。万古霉素MIC为2.0 μ g/ml的MRSA分离株的中位清除时间显著长于MIC为
We examined the relationship between the time to clearance of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia while patients were receiving vancomycin therapy and the in vitro bactericidal activity of vancomycin. Vancomycin killing assays were performed with 34 MRSA bloodstream isolates (17 accessory gene regulator group II [agr-II] and 17 non-agr-II isolates) from 34 different patients with MRSA bacteremia for whom clinical and microbiological outcomes data were available. Vancomycin doses were prospectively adjusted to achieve peak plasma concentrations of 28 to 32 mu g/ml and trough concentrations of 8 to 12 mu g/ml. Bactericidal assays were performed over 24 h with similar to 10(7) to 10(8) CFU/ml in broth containing 16 mu g/ml vancomycin. The median time to clearance of bacteremia was 6.5 days for patients with MRSA isolates demonstrating >= 2.5 reductions in logo CFU/ml at 24 h and > 10.5 days for patients with MRSA isolates demonstrating < 2.5 log(10) CFU/ml by 24 h (P = 0.025). The median time to clearance was significantly longer with MRSA isolates with vancomycin MICs of 2.0 mu g/ml compared to that with MRSA isolates with MICs of