Niinuma Yusuke, Kagami Keisuke, Sugawara Mitsuru, Takekuma Yoh
Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan.
Division of Pharmasciences, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan.
J Chemother. 2025 Jul;37(4):326-333. doi: 10.1080/1120009X.2024.2394326. Epub 2024 Aug 26.
The area under the curve (AUC)/minimum inhibitory concentration (MIC) ratio was used as an indicator of the clinical efficacy of vancomycin. However, the target AUC/MIC has not been set for methicillin-resistant coagulase-negative staphylococci (MR-CNS), and the effectiveness of vancomycin in strains with high MIC is unknown. Therefore, we aimed to investigate the relationship between the vancomycin MIC and therapeutic efficacy in patients with MR-CNS bacteremia. The primary outcome was the difference in treatment failure rate when the MR-CNS vancomycin MIC was 1 or 2 µg/mL. The treatment failure rate did not significantly differ between the two groups (MIC 1 vs. MIC 2: 27.0% vs. 31.0%; = 0.779). As a result of multivariate analysis, AUC/MIC ≤230 was extracted as risk factor for treatment failure, suggesting the importance of a sufficient initial loading dose and early blood concentration monitoring to increase AUC/MIC for successful treatment.
曲线下面积（AUC）与最低抑菌浓度（MIC）的比值被用作万古霉素临床疗效的指标。然而，耐甲氧西林凝固酶阴性葡萄球菌（MR-CNS）尚未设定目标AUC/MIC，万古霉素在高MIC菌株中的有效性尚不清楚。因此，我们旨在研究MR-CNS菌血症患者中万古霉素MIC与治疗效果之间的关系。主要结局是当MR-CNS万古霉素MIC为1或2 μg/mL时治疗失败率的差异。两组之间的治疗失败率无显著差异（MIC 1 vs. MIC 2：27.0% vs. 31.0%；P = 0.779）。多因素分析结果显示，AUC/MIC≤230被确定为治疗失败的危险因素，这表明为成功治疗增加AUC/MIC，充分的初始负荷剂量和早期血药浓度监测很重要。
