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Evaluation of clinical outcome in children and adolescents receiving vancomycin for invasive infections due to methicillin-resistant Staphylococcus aureus: impact of increasing vancomycin MICs.
Evaluation of clinical outcome in children and adolescents receiving vancomycin for invasive infections due to methicillin-resistant Staphylococcus aureus: impact of increasing vancomycin MICs.
- Source :
-
Minerva pediatrica [Minerva Pediatr] 2018 Jun; Vol. 70 (3), pp. 207-211. Date of Electronic Publication: 2016 Dec 22. - Publication Year :
- 2018
-
Abstract
- Background: Vancomycin is the preferred drug for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in children. In adults, treatment failure with vancomycin has been associated with an area under the curve/24 hrs /MIC (AUC24/MIC) ratio of ≤400 and high minimum inhibitory concentrations (MIC ≥1.0 mg/L). Vancomycin dosing information to ensure optimal AUC24/MIC in the pediatric population remains limited.<br />Methods: A retrospective chart review from August 2008 to 2011 and a prospective study from September 2011 to October 2013 was conducted on all pediatric patients at two hospitals in Brooklyn, NY with positive cultures for MRSA who received vancomycin. Treatment failure was defined as persistent positive cultures (≥5 days) or persistence of clinical symptoms. Vancomycin AUC24/MICs were calculated.<br />Results: Twenty-three children with MRSA infection, 0-18 years of age, were identified; 18 of 23 (78.3%) were community acquired. MICs of 91% of the isolates were ≥1.5 µg/mL and 9 had MICs of 2 µg/mL. Treatment failure was seen in 12 (52%) patients with MICs of 1.5 µg/mL and above. Vancomycin trough levels >15 µg/mL and AUC24/MIC >400 were achieved in only 18% and 0% of patients, respectively.<br />Conclusions: High treatment failure rates with vancomycin was associated with MIC ≥1.5 µg/mL. Current recommended vancomycin dosing in children did not achieve a trough concentration of >15 µg/mL in majority of the patients and none achieved an AUC24/MIC>400.
- Subjects :
- Adolescent
Anti-Bacterial Agents administration & dosage
Anti-Bacterial Agents pharmacokinetics
Area Under Curve
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Male
Methicillin-Resistant Staphylococcus aureus isolation & purification
Microbial Sensitivity Tests
New York City
Prospective Studies
Retrospective Studies
Staphylococcal Infections microbiology
Treatment Failure
Treatment Outcome
Vancomycin administration & dosage
Vancomycin pharmacokinetics
Anti-Bacterial Agents therapeutic use
Methicillin-Resistant Staphylococcus aureus drug effects
Staphylococcal Infections drug therapy
Vancomycin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1827-1715
- Volume :
- 70
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Minerva pediatrica
- Publication Type :
- Academic Journal
- Accession number :
- 28006894
- Full Text :
- https://doi.org/10.23736/S0026-4946.16.04688-0