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Association of vancomycin trough concentration on the treatment outcome of patients with bacteremia caused by Enterococcus species

 Yujin Sohn  ;  John Hoon Rim  ;  Yunsuk Cho  ;  Jonghoon Hyun  ;  Yaejee Baek  ;  Moohyun Kim  ;  Jung Ho Kim  ;  Hye Seong  ;  Jin Young Ahn  ;  Sang-Guk Lee  ;  Jong-Beack Lim  ;  Su Jin Jeong  ;  Nam Su Ku  ;  Jun Yong Choi  ;  Joon-Sup Yeom  ;  Young Goo Song 
 BMC INFECTIOUS DISEASES, Vol.21(1) : 1099, 2021-10 
Journal Title
Issue Date
Anti-Bacterial Agents / therapeutic use ; Bacteremia* / drug therapy ; Enterococcus ; Humans ; Methicillin-Resistant Staphylococcus aureus* ; Microbial Sensitivity Tests ; Retrospective Studies ; Staphylococcal Infections* / drug therapy ; Treatment Outcome ; Vancomycin / therapeutic use
AUC/MIC ; Enterococcus ; Trough level ; Vancomycin
Background: Pharmacokinetic-pharmacodynamic (PK/PD) targets of vancomycin therapy have been recognized for methicillin-resistant Staphylococcus aureus infections but not for other gram-positive bacterial infections. Therefore, we investigated whether vancomycin concentration targets such as the trough level and ratio of the area under the curve to minimum inhibitory concentration (AUC/MIC) are associated with the treatment outcome in enterococcal bacteremia.

Methods: A retrospective cohort analysis enrolled patients with bacteremia caused by vancomycin-susceptible Enterococcus faecium and Enterococcus faecalis who were treated with vancomycin from January 2007 to December 2017 at a tertiary hospital located in Seoul, South Korea. Patients without vancomycin concentrations were excluded from the study. The primary outcome was 28-day all-cause mortality.

Results: A total of 37 patients were enrolled-26 with E. faecium infection and 11 with E. faecalis infection. The 28-day all-cause mortality rate was 21.6 %. In univariate analysis, vancomycin trough level (≤ 15 µg/mL; p = 0.042), age (p = 0.044), and septic shock (p = 0.049) were associated with 28-day mortality but not AUC24/MIC (> 389; p = 0.479). In multivariate analysis, vancomycin trough concentration (≤ 15 µg/mL; p = 0.041) and younger age (p = 0.031) were associated with 28-day mortality in patients with enterococcal bacteremia.

Conclusions: In this study, a vancomycin trough level of 15 µg/mL or lower was associated with 28-day mortality in enterococcal bacteremia. However, relatively large prospective studies are needed to examine the efficacy of vancomycin PK/PD parameters in patients with enterococcal bacteremia.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Ku, Nam Su(구남수) ORCID logo https://orcid.org/0000-0002-9717-4327
Kim, Moo Hyun(김무현)
Kim, Jung Ho(김정호) ORCID logo https://orcid.org/0000-0002-5033-3482
Baek, Yae Jee(백예지)
Seong, Hye(성혜) ORCID logo https://orcid.org/0000-0002-5633-7214
Sohn, Yujin(손유진)
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Ahn, Jin Young(안진영) ORCID logo https://orcid.org/0000-0002-3740-2826
Yeom, Joon Sup(염준섭) ORCID logo https://orcid.org/0000-0001-8940-7170
Lee, Sang-Guk(이상국) ORCID logo https://orcid.org/0000-0003-3862-3660
Rim, John Hoon(임정훈) ORCID logo https://orcid.org/0000-0001-6825-8479
Lim, Jong Baeck(임종백) ORCID logo https://orcid.org/0000-0003-0419-0422
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
Cho, Yunsuk(조윤숙)
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
Hyun, Jong Hoon(현종훈) ORCID logo https://orcid.org/0000-0002-9621-0250
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