effect of vancomycin serum trough levels on outcomes in patients with nosocomial pneumonia due to sa
TRANSCRIPT
A Retrospective, post hoc, Subgroup Analysis of the Phase 3 ATTAIN Studies
BMC Infectious Diseases 2014, 14:183
簡百秀
2015.1.21
Existing data are not consistently supportive of improved clinical outcome when vancomycin dosing regimens aimed at achieving target trough levels are used.
Two phase III ATTAIN studies: the efficacy and safety of telavancin vs. vancomycin for treatment of G(+) nosocomial pneumonia in adults patients
Gave vancomycin 1 g Q12H and adjusted for weight and/or renal function.
274 studies sites across 38 countries, total 98 patients with Staphylococcus aureus nosocomial pneumonia and available vancomycin trough levels
Then grouped by vancomycin trough level: < 10 mcg/mL, 10~15 mcg/mL, ≧ 15 mcg/mL.
No significant differences in clinical cure
High vancomycin trough more renal adverse events
1. ARF may have influenced vancomycin distribution and associated with poor clinical outcome
Excluding pt with previous preexisting ARF the same trend
2. Concomitant nephrotoxic medication
3. Limitations: 1) ATTAIN studies were not designed to evaluate the
impact of vancomycin trough levels.
2) Patients were not randomized to achieve a specific trough target.
3) Sample size is too small to draw a definitive conclusion.
95 received
vancomycin
11 nephrotoxicity
1 without other
nephrotoxic
drugs
10 with other
nephrotoxic
drugs
84 no
nephrotoxicity
17 with other
nephrotoxic
drugs
67 without other
nephrotoxic
drugs
11 of 63 high vancomycin
trough group
Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A: High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med 2006, 166(19):2138–2144.
1. Higher vancomycin trough levels Not result in improved clinical response
Increase the incidence of nephrotoxicity.
2. Prospective controlled studies are required to further assess the validity of the current vancomycin dosing recommendations.
Barriere et al. BMC Infectious Diseases 2014, 14:183
Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A: High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med 2006, 166(19):2138–2144.
Association Between Vancomycin Minimum Inhibitory Concentration MIC & Mortality among Patients with Staphylococcus aureus BSIs: a Systematic Review & Meta-analysis. JAMA. 2014;312(15):1552-1564.