• Citer

Continuous vs. intermittent vancomycin therapy for Gram-positive infections not caused by methicillin-resistant Staphylococcus Aureus

par Duszynska, Wieslawa;Taccone, Fabio ;Hurkacz, Magdalena;Wiela-Hojeńska, Anna;Kübler, Andrzej
Référence Minerva anestesiologica, 82, 3, page (284-293)
Publication Publié, 2016-03

Article révisé par les pairs

• Détails
• Contenu

Résumé :

BACKGROUND: The aim of this study was to evaluate the effects of vancomycin pharmacokinetics (PKs) on effectiveness and safety in the treatment of Gram-positive infections due to pathogens other than methicillin-resistant Staphylococcus aureus (MRSA). METHODS: Prospective study including septic patients received either continuous (N.=21) or intermittent (N.=21) infusions of vancomycin; the target drug concentration was 15-20 mg/Land target area under the curve of vancomycin concentrations over the minimum inhibitory concentration of the pathogen on day 1 (AUC24/MIC) >400. Clinical and microbiological responses, the development of acute kidney injury (AKI) and therapy costs were recorded. RESULTS: The median AUC24/MICwas 195(133-343) vs. 189(136-328) mg/L∗h in the continuous and intermittent infusion groups. Target drug concentrations were achieved in 15/21 vs. 9/21 (P=0.12) patients and AUC24/MIC>400 in only 5/21 vs. 3/21 (P=0.35) patients of continuous and intermittent groups, respectively. High clinical cure (17/21 for continuous vs. 17/21 for intermittent, P=1.00) and microbiological eradication (17/21 vs. 15/21, P=0.47) were observed in both groups and not associated with drug concentrations or with AUC24/MIC. AKIwas diagnosed during therapy in 5/21 patients in the continuous group and 8/21 in the intermittent group (P=0.32). The median total therapy costs were lower in the continuous than in the intermittent group (377 [304-485] vs. 552 [371-644] €, P=0.04). CONCLUSIONS: Vancomycin resulted in high clinical response during non-MRSAGram-positive infections treatment even at drug concentrations lower than those for MRSA. Acontinuous infusion of vancomycin was associated with a significant reduction in therapy costs compared to intermittent infusions.