Diagnostic microbiology and infectious disease · 2025
Prediction of treatment success in patients with Enterococcus faecium bacteremia using vancomycin AUC24/MIC ratio: A multicenter retrospective study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Hanai Yuki, Matsumoto Kazuaki, Hanawa Kazumi, Endo Aiju, Hashi Hideki, Miyazaki Taito, Yamaguchi Tetsuo, Harada Sohei, Yokoo Takuya, Uekusa Shusuke, Yokoyama Yoshiaki, Maruyama Riku, Tsujimura Shun, Asakawa Daiki, Namiki Takaya, Isoda Ryo, Enoki Yuki, Taguchi Kazuaki, Matsuo Kazuhiro
Аннотация
BACKGROUND: Although vancomycin is commonly used to treat Enterococcus faecium infections, there are no clear guidelines for the optimal 24-h area under the concentration time curve to minimum inhibitory concentration (AUC24/MIC) ratio. This study aimed to determine the target AUC24/MIC ratio associated with vancomycin-treated E. faecium infection outcomes.
METHODS: This retrospective multicenter cohort study included adult patients who received vancomycin for ≥5 days for E. faecium-associated bloodstream infections between January 2018 and December 2023. The primary outcome was treatment success, defined as a composite of survival beyond 30 days, clinical success, and microbiological eradication. Secondary outcomes included 30-day mortality, clinical success, microbiological eradication, and nephrotoxicity. Receiver operating characteristic (ROC) curve analysis identified the AUC24/MIC cut-off value for treatment success. Multivariate regression analysis was used to determine the association between AUC24/MIC and outcomes.
RESULTS: This study included 81 patients. ROC analysis identified AUC24/MIC ≥427 as the cutoff value for treatment success. The overall treatment success rate (71.6 %) was significantly higher in the above AUC24/MIC cut-off group (81.8 %) than in the below AUC24/MIC cut-off group (59.5 %). On multivariate analysis, AUC24/MIC ≥427 was an independent predictor (adjusted odds ratio: 4.399, 95 % confidence interval: 1.203-19.320, p = 0.024) of treatment success. The clinical success and microbiological eradication rates differed significantly between the below- and above-cut-off groups, whereas nephrotoxicity rates were comparable between the groups.
CONCLUSIONS: In treating E. faecium infections, vancomycin AUC24/MIC ratio ≥427 was independently associated with treatment success. However, further prospective studies are required to confirm the AUC24/MIC target.
METHODS: This retrospective multicenter cohort study included adult patients who received vancomycin for ≥5 days for E. faecium-associated bloodstream infections between January 2018 and December 2023. The primary outcome was treatment success, defined as a composite of survival beyond 30 days, clinical success, and microbiological eradication. Secondary outcomes included 30-day mortality, clinical success, microbiological eradication, and nephrotoxicity. Receiver operating characteristic (ROC) curve analysis identified the AUC24/MIC cut-off value for treatment success. Multivariate regression analysis was used to determine the association between AUC24/MIC and outcomes.
RESULTS: This study included 81 patients. ROC analysis identified AUC24/MIC ≥427 as the cutoff value for treatment success. The overall treatment success rate (71.6 %) was significantly higher in the above AUC24/MIC cut-off group (81.8 %) than in the below AUC24/MIC cut-off group (59.5 %). On multivariate analysis, AUC24/MIC ≥427 was an independent predictor (adjusted odds ratio: 4.399, 95 % confidence interval: 1.203-19.320, p = 0.024) of treatment success. The clinical success and microbiological eradication rates differed significantly between the below- and above-cut-off groups, whereas nephrotoxicity rates were comparable between the groups.
CONCLUSIONS: In treating E. faecium infections, vancomycin AUC24/MIC ratio ≥427 was independently associated with treatment success. However, further prospective studies are required to confirm the AUC24/MIC target.