Pharmacokinetic/pharmacodynamic parameters of teicoplanin for predicting clinical outcome of glycopeptide-susceptible bacteraemia.

OBJECTIVES

The objective of this study was to determine the pharmacokinetic/pharmacodynamic parameters of teicoplanin associated with optimal outcomes in glycopeptide-susceptible (GSEF) bacteraemia.

PATIENTS AND METHODS

We conducted a retrospective review of GSEF bacteraemia cases treated with teicoplanin between 1 April 2009 and 30 May 2023. Total area under the concentration-time curve over 24 h (AUC) was calculated using a Bayesian approach. The free AUC (fAUC) was estimated based on patient serum albumin levels. MICs were determined using the gradient diffusion method (Etest), and the fAUC/MIC ratio was calculated. The primary outcome was treatment failure, defined as a composite of (i) 30-day all-cause mortality and (ii) microbiological failure, defined as persistent bacteraemia (a positive follow-up blood culture obtained >72 h after initiation of appropriate therapy). Classification and regression tree analysis (CART) was employed to identify the optimal teicoplanin fAUC/MIC value associated with treatment failure.

RESULTS

A total of 76 patients were included. Treatment failure occurred in 18 patients (23.7%). A CART-derived teicoplanin fAUC/MIC ≥ 462 was significantly associated with reduced treatment failure ( = 0.002). Multivariable regression analysis revealed that achievement of an fAUC/MIC ≥ 462 was an independent predictor significantly associated with reduced treatment failure (OR, 0.099; 95% CI, 0.005-0.562;  = 0.032).

CONCLUSIONS

An fAUC/MIC ≥ 462 was associated with a reduction in treatment failure in GSEF bacteraemia. Further studies are necessary to establish optimal pharmacokinetic/pharmacodynamic targets for GSEF bacteraemia.