title: A retrospective analysis to estimate target trough concentration of vancomycin for febrile neutropenia in patients with hematological malignancy.
abstract: BACKGROUND
  The target trough concentration of vancomycin in patients with febrile neutropenia has not been reported. The aim of this study was to estimate the target trough concentration for febrile neutropenia in patients with hematological malignancy.
  
  
  METHODS
  In this retrospective, single-center, observational cohort study, 63 hospitalized patients with hematological malignancy who were treated with vancomycin for febrile neutropenia due to bacteriologically documented or presumptive Gram-positive infections were analyzed.
  
  
  RESULTS
  A significant difference in the first trough concentration of vancomycin was observed between the response and non-response groups, and between the nephrotoxicity and non-nephrotoxicity groups. Multiple logistic regression analyses identified the first trough concentration as the only independent variable associated with clinical efficacy and nephrotoxicity of vancomycin. The areas under the ROC curves were 0.72 and 0.83 for clinical efficacy and nephrotoxicity, respectively. The cut-off values of the first trough concentration were 11.1 μg/ml for clinical efficacy (sensitivity 60%, specificity 87%) and 11.9 μg/ml for nephrotoxicity (sensitivity 77%, specificity 82%).
  
  
  CONCLUSIONS
  These results suggest a relationship of trough vancomycin concentration with clinical efficacy and incidence of nephrotoxicity. We propose a target trough vancomycin concentration of around 11.5 μg/ml for febrile neutropenia in patients with hematological malignancy.
authors.affiliation: Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita 879-5593, Japan. Electronic address: y-suzuki@oita-u.ac.jp.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Respiratory Medicine and Infectious Diseases, Oita University, Faculty of Medicine, Hasama-machi, Oita 879-5593, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Tokimatsu
authors.affiliation: Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita 879-5593, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Morinaga
authors.affiliation: Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita 879-5593, Japan.
authors.forename: Yuhki
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Medical Oncology and Hematology, Oita University, Faculty of Medicine, Hasama-machi, Oita 879-5593, Japan.
authors.forename: Kuniko
authors.initials: K
authors.lastname: Takano
authors.affiliation: Department of Medical Oncology and Hematology, Oita University, Faculty of Medicine, Hasama-machi, Oita 879-5593, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kohno
authors.affiliation: Department of Medical Oncology and Hematology, Oita University, Faculty of Medicine, Hasama-machi, Oita 879-5593, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Ogata
authors.affiliation: Department of Respiratory Medicine and Infectious Diseases, Oita University, Faculty of Medicine, Hasama-machi, Oita 879-5593, Japan.
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Hiramatsu
authors.affiliation: Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita 879-5593, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Itoh
authors.affiliation: Department of Respiratory Medicine and Infectious Diseases, Oita University, Faculty of Medicine, Hasama-machi, Oita 879-5593, Japan.
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kadota
mesh_terms: D000328:Adult; D000368:Aged; D016903:Drug Monitoring / Q000379:methods; D064147:Febrile Neutropenia / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use*
chemical_list: D014640:Vancomycin
keywords: Febrile neutropenia; Hematological malignancy; Therapeutic drug monitoring; Vancomycin