{"title":"万古霉素 AUC24/MIC 比值对重症或并发耐甲氧西林金黄色葡萄球菌感染患者 30 天死亡率的预测价值：一项多中心回顾性研究。","authors":"Yuki Hanai, Hideki Hashi, Kazumi Hanawa, Aiju Endo, Taito Miyazaki, Tetsuo Yamaguchi, Sohei Harada, Takuya Yokoo, Shusuke Uekusa, Takaya Namiki, Yoshiaki Yokoyama, Daiki Asakawa, Ryo Isoda, Yuki Enoki, Kazuaki Taguchi, Kazuaki Matsumoto, Kazuhiro Matsuo","doi":"10.1007/s11095-024-03728-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Although vancomycin is typically employed against methicillin-resistant Staphylococcus aureus (MRSA) infections, the optimal ratio of 24-h area under the concentration-time curve to minimum inhibitory concentration (AUC<sub>24</sub>/MIC) for severe or complicated infections lacks clear guideline recommendations. This study aimed to determine the target AUC<sub>24</sub>/MIC ratio associated with treatment outcomes of infections treated with vancomycin.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study included adult patients receiving ≥ 5 days of vancomycin for severe/complicated MRSA infections (e.g., osteoarticular, pulmonary, endocarditis, etc.) between January 2018 and December 2023. The primary outcome was 30-day mortality, with secondary outcomes including clinical success, microbiological eradication, and nephrotoxicity. Receiver operating characteristic (ROC) curve analysis was used to identify the AUC<sub>24</sub>/MIC cutoff for 30-day mortality. Multivariate regression analysis was used to determine association between AUC<sub>24</sub>/MIC and outcomes.</p><p><strong>Results: </strong>This study included 82 patients. ROC identified a target AUC<sub>24</sub>/MIC of ≥ 505 for 30-day mortality. The overall 30-day mortality rate (22.0%) was significantly higher for below average AUC<sub>24</sub>/MIC cutoff (34.1%) than for above AUC<sub>24</sub>/MIC cutoff group (9.8%). Multivariate analysis confirmed AUC<sub>24</sub>/MIC of < 505 as an independent predictor (adjusted odds ratio, 5.001; 95% confidence interval, 1.335-18.75). The clinical success rate differed significantly between below- and above-cutoff groups, whereas microbiological eradication tended to favor the above-cutoff group. The nephrotoxicity rates were comparable between groups.</p><p><strong>Conclusions: </strong>In treating severe/complicated MRSA infections, vancomycin AUC<sub>24</sub>/MIC ratio ≥ 505 was independently associated with favorable 30-day mortality. Given the retrospective nature of this study, further prospective studies are essential to confirm the reliability of the target AUC<sub>24</sub>/MIC ratios.</p>","PeriodicalId":3,"journal":{"name":"ACS Applied Electronic Materials","volume":null,"pages":null},"PeriodicalIF":4.3000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictive Value of Vancomycin AUC<sub>24</sub>/MIC Ratio for 30-day Mortality in Patients with Severe or Complicated Methicillin-Resistant Staphylococcus aureus Infections: A Multicenter Retrospective Study.\",\"authors\":\"Yuki Hanai, Hideki Hashi, Kazumi Hanawa, Aiju Endo, Taito Miyazaki, Tetsuo Yamaguchi, Sohei Harada, Takuya Yokoo, Shusuke Uekusa, Takaya Namiki, Yoshiaki Yokoyama, Daiki Asakawa, Ryo Isoda, Yuki Enoki, Kazuaki Taguchi, Kazuaki Matsumoto, Kazuhiro Matsuo\",\"doi\":\"10.1007/s11095-024-03728-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Although vancomycin is typically employed against methicillin-resistant Staphylococcus aureus (MRSA) infections, the optimal ratio of 24-h area under the concentration-time curve to minimum inhibitory concentration (AUC<sub>24</sub>/MIC) for severe or complicated infections lacks clear guideline recommendations. This study aimed to determine the target AUC<sub>24</sub>/MIC ratio associated with treatment outcomes of infections treated with vancomycin.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study included adult patients receiving ≥ 5 days of vancomycin for severe/complicated MRSA infections (e.g., osteoarticular, pulmonary, endocarditis, etc.) between January 2018 and December 2023. The primary outcome was 30-day mortality, with secondary outcomes including clinical success, microbiological eradication, and nephrotoxicity. Receiver operating characteristic (ROC) curve analysis was used to identify the AUC<sub>24</sub>/MIC cutoff for 30-day mortality. Multivariate regression analysis was used to determine association between AUC<sub>24</sub>/MIC and outcomes.</p><p><strong>Results: </strong>This study included 82 patients. ROC identified a target AUC<sub>24</sub>/MIC of ≥ 505 for 30-day mortality. The overall 30-day mortality rate (22.0%) was significantly higher for below average AUC<sub>24</sub>/MIC cutoff (34.1%) than for above AUC<sub>24</sub>/MIC cutoff group (9.8%). Multivariate analysis confirmed AUC<sub>24</sub>/MIC of < 505 as an independent predictor (adjusted odds ratio, 5.001; 95% confidence interval, 1.335-18.75). The clinical success rate differed significantly between below- and above-cutoff groups, whereas microbiological eradication tended to favor the above-cutoff group. The nephrotoxicity rates were comparable between groups.</p><p><strong>Conclusions: </strong>In treating severe/complicated MRSA infections, vancomycin AUC<sub>24</sub>/MIC ratio ≥ 505 was independently associated with favorable 30-day mortality. Given the retrospective nature of this study, further prospective studies are essential to confirm the reliability of the target AUC<sub>24</sub>/MIC ratios.</p>\",\"PeriodicalId\":3,\"journal\":{\"name\":\"ACS Applied Electronic Materials\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ACS Applied Electronic Materials\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11095-024-03728-9\",\"RegionNum\":3,\"RegionCategory\":\"材料科学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ENGINEERING, ELECTRICAL & ELECTRONIC\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Electronic Materials","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11095-024-03728-9","RegionNum":3,"RegionCategory":"材料科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/17 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ENGINEERING, ELECTRICAL & ELECTRONIC","Score":null,"Total":0}
Predictive Value of Vancomycin AUC24/MIC Ratio for 30-day Mortality in Patients with Severe or Complicated Methicillin-Resistant Staphylococcus aureus Infections: A Multicenter Retrospective Study.
Background: Although vancomycin is typically employed against methicillin-resistant Staphylococcus aureus (MRSA) infections, the optimal ratio of 24-h area under the concentration-time curve to minimum inhibitory concentration (AUC24/MIC) for severe or complicated infections lacks clear guideline recommendations. This study aimed to determine the target AUC24/MIC ratio associated with treatment outcomes of infections treated with vancomycin.
Methods: This retrospective multicenter cohort study included adult patients receiving ≥ 5 days of vancomycin for severe/complicated MRSA infections (e.g., osteoarticular, pulmonary, endocarditis, etc.) between January 2018 and December 2023. The primary outcome was 30-day mortality, with secondary outcomes including clinical success, microbiological eradication, and nephrotoxicity. Receiver operating characteristic (ROC) curve analysis was used to identify the AUC24/MIC cutoff for 30-day mortality. Multivariate regression analysis was used to determine association between AUC24/MIC and outcomes.
Results: This study included 82 patients. ROC identified a target AUC24/MIC of ≥ 505 for 30-day mortality. The overall 30-day mortality rate (22.0%) was significantly higher for below average AUC24/MIC cutoff (34.1%) than for above AUC24/MIC cutoff group (9.8%). Multivariate analysis confirmed AUC24/MIC of < 505 as an independent predictor (adjusted odds ratio, 5.001; 95% confidence interval, 1.335-18.75). The clinical success rate differed significantly between below- and above-cutoff groups, whereas microbiological eradication tended to favor the above-cutoff group. The nephrotoxicity rates were comparable between groups.
Conclusions: In treating severe/complicated MRSA infections, vancomycin AUC24/MIC ratio ≥ 505 was independently associated with favorable 30-day mortality. Given the retrospective nature of this study, further prospective studies are essential to confirm the reliability of the target AUC24/MIC ratios.
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