title: The association of elevated trough serum vancomycin concentrations with obesity.
abstract: BACKGROUND
  Obese patients display differences in vancomycin drug disposition, which may complicate attainment of appropriate serum vancomycin concentrations (SVCs). This study was conducted to determine if obesity leads to trough SVCs above the therapeutic range.
  
  
  METHODS
  This retrospective cohort study sought to determine the rate and predictors of high (i.e. >20 mg/L) serum trough levels according to level of obesity.
  
  
  RESULTS
  Increasing BMI predicted SVCs > 20 mg/L after controlling for dose, age, and serum creatinine. Obese patients had significantly higher mean trough SVCs compared to non-obese patients (16.5 mg/L vs 12.1 mg/L, p = 0.004) and a significantly higher proportion of obese patients had trough SVCs > 20 mg/L (18.9% vs 4.2%, p = 0.03).
  
  
  CONCLUSIONS
  Increasing obesity predicted higher probabilities of SVCs > 20 mg/L. Development of alternative dosing and management strategies for vancomycin may be necessary to account for pharmacokinetic changes associated with obesity.
authors: Captain James A. Lovell Federal Health Care Center, 3001 Green Bay Rd, North Chicago, IL 60064, USA; Mercy Hospital & Medical Center, 2525 S. Michigan Avenue, Chicago, IL 60616, USA. Electronic address: Janice.Richardson2@va.gov.
authors: Janice
authors: J
authors: Richardson
authors: Midwestern University, Chicago College of Pharmacy, 555 31st St, Downers Grove, IL 60515, USA; Northwestern Memorial Hospital, Department of Pharmacy, 251 E. Huron St., Chicago, IL 60611, USA. Electronic address: mschee@midwestern.edu.
authors: Marc
authors: M
authors: Scheetz
authors: Mercy Hospital & Medical Center, 2525 S. Michigan Avenue, Chicago, IL 60616, USA; Midwestern University, Chicago College of Pharmacy, 555 31st St, Downers Grove, IL 60515, USA; Rush University Medical Center, Department of Pharmacy, 1653 W. Congress Pkwy., Chicago, IL 60612, USA. Electronic address: podonn@midwestern.edu.
authors: E Paul
authors: EP
authors: O'Donnell
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000378:metabolism*; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Antibacterials; Antibiotic therapy; Pharmacokinetics