Relationship between day 1 and day 2 Vancomycin area under the curve values and emergence of heterogeneous Vancomycin-intermediate Staphylococcus aureus (hVISA) by Etest® macromethod among patients with MRSA bloodstream infections: a pilot study.
Relationship between day 1 and day 2 Vancomycin area under the curve values and emergence of heterogeneous Vancomycin-intermediate Staphylococcus aureus (hVISA) by Etest® macromethod among patients with MRSA bloodstream infections: a pilot study.
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DOI：
10.1186/s12879-017-2609-0
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发表时间：
2017-08-02
影响因子：
3.7
通讯作者：
Lodise TP
中科院分区：
文献类型：
--
作者：
Martirosov DM;Bidell MR;Pai MP;Scheetz MH;Rosenkranz SL;Faragon C;Malik M;Mendes RE;Jones RN;McNutt LA;Lodise TP
体外数据表明，次优初始万古霉素暴露可能选择异质性万古霉素中间金黄色葡萄球菌（hVISA）感染。然而，没有临床研究评价初始万古霉素暴露与hVISA出现之间的关系。该初步研究旨在评估基线时非hVISA BSI患者中第1天和第2天万古霉素曲线下面积（AUC）与通过Etest®宏观方法发生hVISA血流感染（BSI）之间的关系。这是一项在2005年1月至2009年6月期间在奥尔巴尼医学中心医院（AMCH）进行的耐甲氧西林金黄色葡萄球菌（MRSA）BSI患者的回顾性队列研究。使用ADAPT 5中的最大后验概率（MAP）程序估计第1天（AUC 0 - 24 h）和第2天（AUC 24 - 48 h）的万古霉素AUC暴露变量。在研究期间，有238例MRSA BSI的独特发作，其中119例符合入选标准。总体而言，hVISA在7/119（5.9%）例患者中出现。所有7例hVISA病例均涉及未达到肉汤微量稀释最低抑菌浓度曲线下面积（AUC 0 - 24 h/MICBMD）比值521或AUC 24 - 48 h/MICBMD比值650的患者。未观察到其他第1天和第2天AUC变量与hVISA出现之间的相关性。虽然需要更多的数据来得出明确的结论，但这些结果表明，基线时非hVISA MRSA BSI患者中出现hVISA可能部分解释为治疗前1 - 2天万古霉素暴露不佳。至少，这些发现支持在一项把握度良好的多中心前瞻性试验中进一步研究MRSA BSI患者中初始万古霉素暴露与hVISA出现之间的关系。
In vitro data suggests that suboptimal initial vancomycin exposure may select for heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) infections. However, no clinical studies have evaluated the relationship between initial vancomycin exposure and emergence of hVISA. This pilot study seeks to assess the relationship between day 1 and day 2 vancomycin area under the curve (AUC) and emergence of hVISA bloodstream infections (BSIs) by Etest® macromethod among patients with a non-hVISA BSI at baseline. This was a retrospective cohort study of patients with methicillin-resistant Staphylococcus aureus (MRSA) BSIs at Albany Medical Center Hospital (AMCH) between January 2005 and June 2009. The vancomycin AUC exposure variables on day 1 (AUC0-24h) and day 2 (AUC24-48h) were estimated using the maximal a posteriori probability (MAP) procedure in ADAPT 5. There were 238 unique episodes of MRSA BSIs during the study period, 119 of which met inclusion criteria. Overall, hVISA emerged in 7/119 (5.9%) of patients. All 7 cases of hVISA involved patients who did not achieve area under the curve over broth microdilution minimum inhibitory concentration (AUC0-24h/MICBMD) ratio of 521 or an AUC24-48h/MICBMD ratio of 650. No associations between other day 1 and day 2 AUC variables and emergence of hVISA were noted. Although more data are needed to draw definitive conclusions, these findings suggest that hVISA emergence among patients with non-hVISA MRSA BSIs at baseline may be partially explained by suboptimal exposure to vancomycin in the first 1 to 2 days of therapy. At a minimum, these findings support further study of the relationship between initial vancomycin exposure and hVISA emergence among patients with MRSA BSIs in a well-powered, multi-center, prospective trial.
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影响因子：
4.9
作者：
Neely, Michael N.;Youn, Gilmer;Lodise, Thomas P.
通讯作者：
Lodise, Thomas P.
影响因子：
11.8
作者：
Liu, Catherine;Bayer, Arnold;Chambers, Henry F.
通讯作者：
Chambers, Henry F.
影响因子：
9.4
作者：
Wootton, Mandy;MacGowan, Alasdair P.;Howe, Robin A.
通讯作者：
Howe, Robin A.
影响因子：
5.2
作者：
Wootton, M;Howe, RA;MacGowan, AP
通讯作者：
MacGowan, AP
影响因子：
11.8
作者：
Lodise, Thomas P.;Drusano, George L.;McNutt, Louise-Anne
通讯作者：
McNutt, Louise-Anne