Martirosov D M, Bidell M R, Pai M P, Scheetz M H, Rosenkranz S L, Lodise T P
Albany College of Pharmacy and Health Sciences, 106 New Scotland Ave, Albany, NY 12008, USA.
Midwestern University Chicago College of Pharmacy, 555 31st Street, Downers Grove, IL 60515, USA.
Diagn Microbiol Infect Dis. 2017 Jul;88(3):259-263. doi: 10.1016/j.diagmicrobio.2017.03.008. Epub 2017 Apr 2.
Data suggest that vancomycin is less effective for methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) with vancomycin Etest® MIC (MIC) ≥1.5 mg/L. No published studies have evaluated the relationship between vancomycin exposure and outcomes among patients with MRSA BSIs vancomycin MIC ≥1.5 mg/L. This study was a retrospective cohort of 71 hospitalized, adult, non-dialysis patients with MRSA BSIs treated with vancomycin. All but three patients had a vancomycin MIC of 1.5 mg/L. Achievement of CART-derived AUC of at least 550 mgh/L (AUC/MIC of 366 mgh/L) was associated with a lower incidence of treatment failure. In multivariate analyses, the risk ratio was 0.45 for the CART-derived AUC threshold, indicating that achievement of the CART-derived AUC threshold of 550 was associated with a 2-fold decrease in treatment failure. These findings suggest a potential association between vancomycin exposure and outcomes in patients with MRSA BSIs with MIC ≥1.5 mg/L. As this study was retrospective, these findings provide the basis for a future large-scale, multi-center prospective study.
数据表明，对于万古霉素Etest®最低抑菌浓度（MIC）≥1.5mg/L的耐甲氧西林金黄色葡萄球菌（MRSA）血流感染（BSI），万古霉素疗效较差。尚无已发表的研究评估万古霉素暴露与万古霉素MIC≥1.5mg/L的MRSA BSI患者预后之间的关系。本研究是一项回顾性队列研究，纳入71例接受万古霉素治疗的住院成年非透析MRSA BSI患者。除3例患者外，所有患者的万古霉素MIC均为1.5mg/L。达到CART衍生的曲线下面积（AUC）至少550mgh/L（AUC/MIC为366mgh/L）与较低的治疗失败发生率相关。在多变量分析中，CART衍生的AUC阈值的风险比为0.45，表明达到550的CART衍生AUC阈值与治疗失败降低2倍相关。这些发现提示万古霉素暴露与MIC≥1.5mg/L的MRSA BSI患者预后之间可能存在关联。由于本研究为回顾性研究，这些发现为未来大规模、多中心前瞻性研究提供了依据。
