Hanai Yuki, Matsumoto Kazuaki, Endo Aiju, Hanawa Kazumi, Hashi Hideki, Miyazaki Taito, Yamaguchi Tetsuo, Harada Sohei, Yokoo Takuya, Uekusa Shusuke, Asakawa Daiki, Yokoyama Yoshiaki, Maruyama Riku, Tsujimura Shun, Namiki Takaya, Isoda Ryo, Enoki Yuki, Taguchi Kazuaki, Matsuo Kazuhiro
Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan.
Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan.
J Antimicrob Chemother. 2025 Feb 3;80(2):538-546. doi: 10.1093/jac/dkae442.
Although vancomycin is commonly used to treat methicillin-resistant coagulase-negative staphylococci (MRCoNS) infections, there are no clear guidelines for the optimal 24 h AUC24/MIC ratio. This study aimed to determine the target AUC24/MIC ratio associated with vancomycin-treated MRCoNS infection outcomes.
This multicentre retrospective cohort study included adult patients who received vancomycin for ≥5 days for bloodstream infections caused by MRCoNS between January 2018 and December 2023. Primary outcome was treatment success, defined as a composite of survival beyond 30 days, clinical success and microbiological eradication. Secondary outcomes included 30-day mortality, clinical success, microbiological eradication and nephrotoxicity. Receiver operating characteristic (ROC) curve analysis was used to identify the AUC24/MIC cut-off for treatment success. Multivariate regression analysis was used to determine the association between AUC24/MIC and outcomes.
This study included 147 patients. ROC analysis identified a target AUC24/MIC ≥373 for treatment success. The overall treatment success rate (70.1%) was significantly higher in the above-average AUC24/MIC cut-off group (83.1%) than that in the below AUC24/MIC cut-off group (57.9%). Multivariate analysis confirmed that AUC24/MIC ≥373 was an independent predictor (adjusted OR = 10.227; 95% CI = 3.585-29.171). The 30-day mortality and microbiological eradication rates differed significantly between the below- and above-cut-off groups, whereas nephrotoxicity rates were comparable among the groups.
In treating MRCoNS infections, vancomycin AUC24/MIC ratio ≥373 was independently associated with favourable treatment outcomes. However, further prospective studies are required to confirm this target owing to the retrospective nature of this study.
尽管万古霉素常用于治疗耐甲氧西林凝固酶阴性葡萄球菌（MRCoNS）感染，但对于最佳的24小时AUC24/MIC比值尚无明确指南。本研究旨在确定与万古霉素治疗MRCoNS感染结局相关的目标AUC24/MIC比值。
这项多中心回顾性队列研究纳入了2018年1月至2023年12月期间因MRCoNS引起的血流感染接受万古霉素治疗≥5天的成年患者。主要结局为治疗成功，定义为30天以上生存、临床成功和微生物清除的综合结果。次要结局包括30天死亡率、临床成功、微生物清除和肾毒性。采用受试者工作特征（ROC）曲线分析确定治疗成功的AUC24/MIC临界值。多变量回归分析用于确定AUC24/MIC与结局之间的关联。
本研究纳入了147例患者。ROC分析确定治疗成功的目标AUC24/MIC≥373。AUC24/MIC临界值高于平均水平的组（83.1%）的总体治疗成功率（70.1%）显著高于AUC24/MIC临界值以下的组（57.9%）。多变量分析证实AUC24/MIC≥373是一个独立预测因素（校正OR=10.227；95%CI=3.585-29.171）。临界值以下和以上组之间的30天死亡率和微生物清除率存在显著差异，而各组之间的肾毒性率相当。
在治疗MRCoNS感染时，万古霉素AUC24/MIC比值≥373与良好的治疗结局独立相关。然而，由于本研究的回顾性性质，需要进一步的前瞻性研究来证实这一目标。
