title: Are Vancomycin Trough Concentrations of 15 to 20 mg/L Associated With Increased Attainment of an AUC/MIC ≥ 400 in Patients With Presumed MRSA Infection?
abstract: OBJECTIVE
  To determine whether there is an association between higher vancomycin trough concentrations and attainment of a calculated area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC) ≥400.
  
  
  METHODS
  A retrospective analysis was conducted among vancomycin-treated adult patients with a positive methicillin-resistant Staphylococcus aureus (MRSA) culture. Attainment of a calculated AUC/MIC ≥400 was compared between patients with troughs in the reference range of 15 to 20 mg/L and those with troughs in the following ranges: <10, 10 to 14.9, and >20 mg/L. Nephrotoxicity was assessed as a secondary outcome based on corrected average vancomycin troughs over 10 days of treatment.
  
  
  RESULTS
  Overall, 226 patients were reviewed and 100 included. Relative to troughs ≥10, patients with vancomycin troughs <10 mg/L were 73% less likely to attain an AUC/MIC ≥400 (odds ratio [OR] 0.27, 95% confidence interval [CI]: 0.01-0.75). No difference was found in the attainment of an AUC/MIC ≥400 in patients with troughs of 10 to 14.9 mg/L and >20 mg/L when compared to patients with troughs of 15 to 20 mg/L. The mean corrected average vancomycin trough was higher in patients developing nephrotoxicity compared to those who did not (19.5 vs 14.5 mg/L, P < .001).
  
  
  CONCLUSIONS
  Achieving vancomycin serum trough concentrations of 15 to 20 mg/L did not result in an increased attainment of the AUC/MIC target relative to troughs of 10 to 14.9 mg/L but may increase nephrotoxicity risk.
authors.affiliation: 1 Department of Pharmacy, Upstate University Hospital, Syracuse, New York, NY, USA.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Hale
authors.affiliation: 1 Department of Pharmacy, Upstate University Hospital, Syracuse, New York, NY, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Seabury
authors.affiliation: 1 Department of Pharmacy, Upstate University Hospital, Syracuse, New York, NY, USA.|2 Department of Medicine, Upstate Medical University, Syracuse, New York, NY, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Steele
authors.affiliation: 1 Department of Pharmacy, Upstate University Hospital, Syracuse, New York, NY, USA.|2 Department of Medicine, Upstate Medical University, Syracuse, New York, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Darko
authors.affiliation: 1 Department of Pharmacy, Upstate University Hospital, Syracuse, New York, NY, USA.|2 Department of Medicine, Upstate Medical University, Syracuse, New York, NY, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000097:blood* / Q000494:pharmacology / Q000627:therapeutic use; D019540:Area Under Curve; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000097:blood* / Q000188:drug therapy*; D014640:Vancomycin / Q000097:blood* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Staphylococcus aureus; area under the curve (AUC); pharmacodynamic; pharmacokinetic; vancomycin