{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T06:41:12Z","timestamp":1763534472310,"version":"3.44.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"SK Bioscience and the Korean Society of Pediatric Infectious Diseases","award":["1"],"award-info":[{"award-number":["1"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>The optimal vancomycin area under the concentration-time curve (AUC) target for pediatric methicillin-resistant <jats:italic toggle=\"yes\">Staphylococcus aures<\/jats:italic> (MRSA) bacteremia remains unclear. This study aimed to determine the optimal AUC target using Bayesian software.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>A retrospective analysis was conducted on patients 3 months to 18 years of age diagnosed with MRSA bacteremia at Asan Medical Center Children`s Hospital between September 2013 and December 2021. The vancomycin AUC was estimated using Bayesian software, and the relationship between AUC<jats:sub>24\u201348<\/jats:sub> and outcomes, including persistent bacteremia \u226548 hours, acute kidney injury (AKI), 30-day all-cause mortality and recurrence, was analyzed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Fifty-six cases were included, with a median age of 2.4 years. Most cases were healthcare-associated infections (96.4%) and occurred in patients with underlying conditions (92.9%). Persistent bacteremia, recurrent bacteremia, 30-day all-cause mortality and AKI were observed in 17.9%, 14.8%, 3.7% and 7.1%, respectively. Although an AUC<jats:sub>24\u201348<\/jats:sub> \u2265400 mg\u00b7h\/L did not demonstrate clinical benefit, the receiver operating characteristic curve analysis identified 530 mg\u00b7h\/L as the appropriate AUC<jats:sub>24\u201348<\/jats:sub> threshold for predicting persistent bacteremia and AKI. Persistent bacteremia and AKI were more frequent in patients with AUC<jats:sub>24\u201348<\/jats:sub> &gt;530 mg\u00b7h\/L (62.5% vs. 10.4%, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01; 37.5% vs. 2.1%, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01). No significant differences in 30-day mortality or recurrence were observed between the groups with AUC<jats:sub>24\u201348<\/jats:sub> above and below this threshold.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>AUC<jats:sub>24\u201348<\/jats:sub> \u2264530 mg\u00b7h\/L was associated with reduced persistent bacteremia and AKI in pediatric MRSA bacteremia, without significant disadvantages in mortality and recurrence. Future research should explore the lower limit of AUC targets to optimize vancomycin therapy in pediatric patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/inf.0000000000004841","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T17:00:39Z","timestamp":1750957239000},"page":"942-948","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Optimal Vancomycin AUC Target in Pediatric MRSA Bacteremia: A Bayesian-guided Approach"],"prefix":"10.1097","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8990-4273","authenticated-orcid":false,"given":"Yonghee","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"},{"name":"Department of Pediatrics, Gangwon National University Hospital, Chuncheon, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2594-6543","authenticated-orcid":false,"given":"Gahee","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"},{"name":"Department of Pediatrics, Chosun University Hospital, Gwangju, Republic of Korea."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3435-251X","authenticated-orcid":false,"given":"Jina","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"R1-20250924","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1086\/491712","article-title":"The pharmacokinetic and pharmacodynamic properties of vancomycin.","volume":"42","author":"Rybak","year":"2006","journal-title":"Clin Infect Dis"},{"key":"R2-20250924","doi-asserted-by":"crossref","first-page":"82","DOI":"10.2146\/ajhp080434","article-title":"Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists.","volume":"66","author":"Rybak","year":"2009","journal-title":"Am J Health Syst Pharm"},{"key":"R3-20250924","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1128\/AAC.01653-13","article-title":"Are vancomycin trough concentrations adequate for optimal dosing?","volume":"58","author":"Neely","year":"2014","journal-title":"Antimicrob Agents Chemother"},{"key":"R4-20250924","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1093\/cid\/cir078","article-title":"Vancomycin: we can\u2019t get there from here.","volume":"52","author":"Patel","year":"2011","journal-title":"Clin Infect Dis"},{"key":"R5-20250924","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1093\/cid\/ciu398","article-title":"Vancomycin exposure in patients with methicillin-resistant Staphylococcus aureus bloodstream infections: how much is enough?","volume":"59","author":"Lodise","year":"2014","journal-title":"Clin Infect Dis"},{"key":"R6-20250924","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1093\/cid\/ciz051","article-title":"Vancomycin area under the curve and acute kidney injury: a meta-analysis.","volume":"69","author":"Aljefri","year":"2019","journal-title":"Clin Infect Dis"},{"key":"R7-20250924","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1093\/ajhp\/zxaa036","article-title":"Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.","volume":"77","author":"Rybak","year":"2020","journal-title":"Am J Health Syst Pharm"},{"key":"R8-20250924","doi-asserted-by":"crossref","first-page":"e01102","DOI":"10.1128\/AAC.01102-19","article-title":"Early bayesian dose adjustment of vancomycin continuous infusion in children: a randomized controlled trial.","volume":"63","author":"Berthaud","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"R9-20250924","doi-asserted-by":"crossref","first-page":"925","DOI":"10.2165\/00003088-200443130-00005","article-title":"Pharmacodynamics of vancomycin and other antimicrobials in patients with Staphylococcus aureus lower respiratory tract infections.","volume":"43","author":"Moise-Broder","year":"2004","journal-title":"Clin Pharmacokinet"},{"key":"R10-20250924","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1128\/AAC.01485-12","article-title":"Vancomycin AUC\/MIC ratio and 30-day mortality in patients with Staphylococcus aureus bacteremia.","volume":"57","author":"Holmes","year":"2013","journal-title":"Antimicrob Agents Chemother"},{"key":"R11-20250924","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ijantimicag.2013.10.017","article-title":"Area under the concentration-time curve to minimum inhibitory concentration ratio as a predictor of vancomycin treatment outcome in methicillin-resistant Staphylococcus aureus bacteraemia.","volume":"43","author":"Jung","year":"2014","journal-title":"Int J Antimicrob Agents"},{"key":"R12-20250924","first-page":"472","article-title":"Vancomycin therapeutic drug monitoring in children: new recommendations, similar challenges.","volume":"25","author":"McNeil","year":"2020","journal-title":"J Pediatr Pharmacol Ther"},{"key":"R13-20250924","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1097\/FTD.0000000000000190","article-title":"Evaluation of target attainment of vancomycin area under the curve in children with methicillin-resistant staphylococcus aureus bacteremia.","volume":"37","author":"Hahn","year":"2015","journal-title":"Ther Drug Monit"},{"key":"R14-20250924","first-page":"312","article-title":"Vancomycin treatment failure in children with methicillin-resistant staphylococcus aureus bacteremia.","volume":"24","author":"Regen","year":"2019","journal-title":"J Pediatr Pharmacol Ther"},{"key":"R15-20250924","doi-asserted-by":"crossref","first-page":"e0247714","DOI":"10.1371\/journal.pone.0247714","article-title":"Impact of initial vancomycin pharmacokinetic\/pharmacodynamic parameters on the clinical and microbiological outcomes of methicillin-resist ant Staphylococcus aureus bacteremia in children.","volume":"16","author":"Yoo","year":"2021","journal-title":"PLoS One"},{"key":"R16-20250924","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.ijantimicag.2008.05.007","article-title":"A. Comparison of method-specific vancomycin minimum inhibitory concentration values and their predictability for treatment outcome of meticillin-resistant Staphylococcus aureus (MRSA) infections.","volume":"32","author":"Hsu","year":"2008","journal-title":"Int J Antimicrob Agents"},{"key":"R17-20250924","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1128\/JCM.00448-13","article-title":"Evaluation of vancomycin susceptibility testing for methicillin-resistant Staphylococcus aureus: comparison of Etest and three automated testing methods.","volume":"51","author":"Rybak","year":"2013","journal-title":"J Clin Microbiol"},{"key":"R18-20250924","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0031-3955(16)36251-4","article-title":"The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents.","volume":"34","author":"Schwartz","year":"1987","journal-title":"Pediatr Clin North Am"},{"key":"R19-20250924","doi-asserted-by":"crossref","first-page":"791","DOI":"10.7326\/0003-4819-137-10-200211190-00007","article-title":"Health care\u2013associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections.","volume":"137","author":"Friedman","year":"2002","journal-title":"Ann Intern Med"},{"key":"R20-20250924"},{"key":"R21-20250924","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1086\/599376","article-title":"Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America.","volume":"49","author":"Mermel","year":"2009","journal-title":"Clin Infect Dis"},{"key":"R22-20250924","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1086\/377540","article-title":"Outcome of Staphylococcus aureus bacteremia in patients with eradicable foci versus noneradicable foci.","volume":"37","author":"Kim","year":"2003","journal-title":"Clin Infect Dis"},{"key":"R24-20250924","doi-asserted-by":"crossref","first-page":"e155","DOI":"10.1097\/INF.0b013e318286378e","article-title":"Improved vancomycin dosing in children using area under the curve exposure.","volume":"32","author":"Le","year":"2013","journal-title":"Pediatr Infect Dis J"},{"key":"R25-20250924","first-page":"1017","article-title":"Population-based pharmacokinetic modeling of vancomycin in children with renal insufficiency.","volume":"2","author":"Le","year":"2014","journal-title":"J Pharmacol Clin Toxicol"},{"key":"R26-20250924","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1093\/cid\/ciz460","article-title":"The Emperor\u2019s new clothes: prospective observational evaluation of the association between initial vancomycin exposure and failure rates among adult hospitalized patients with methicillin-resistant Staphylococcus aureus bloodstream infections (PROVIDE).","volume":"70","author":"Lodise","year":"2020","journal-title":"Clin Infect Dis"},{"key":"R27-20250924","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.addr.2014.05.016","article-title":"Innovative approaches to optimizing the delivery of vancomycin in individual patients.","volume":"77","author":"Pai","year":"2014","journal-title":"Adv Drug Deliv Rev"},{"key":"R28-20250924","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1177\/08971900211012395","article-title":"Assessment of the implementation of AUC dosing and monitoring practices with vancomycin at hospitals across the United States.","volume":"35","author":"Bradley","year":"2022","journal-title":"J Pharm Pract"},{"key":"R29-20250924","doi-asserted-by":"crossref","first-page":"1346.e1","DOI":"10.1016\/j.cmi.2020.11.008","article-title":"Cost-benefit analysis comparing trough, two-level AUC and Bayesian AUC dosing for vancomycin.","volume":"27","author":"Lee","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"R30-20250924","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1093\/cid\/ciz257","article-title":"Defining the breakpoint duration of Staphylococcus aureus bacteremia predictive of poor outcomes.","volume":"70","author":"Minejima","year":"2020","journal-title":"Clin Infect Dis"},{"key":"R31-20250924","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/INF.0000000000000991","article-title":"Healthcare-associated Staphylococcus aureus bacteremia in children: evidence for reverse vancomycin creep and impact of vancomycin trough values on outcome.","volume":"35","author":"McNeil","year":"2016","journal-title":"Pediatr Infect Dis J"},{"key":"R32-20250924","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1001\/jamapediatrics.2016.1477","article-title":"Epidemiology and mortality of Staphylococcus aureus bacteremia in Australian and New Zealand children.","volume":"170","author":"McMullan","year":"2016","journal-title":"JAMA Pediatr"},{"key":"R33-20250924","doi-asserted-by":"crossref","first-page":"e20170183","DOI":"10.1542\/peds.2017-0183","article-title":"Epidemiology of methicillin-resistant Staphylococcus aureus bacteremia in children.","volume":"139","author":"Hamdy","year":"2017","journal-title":"Pediatrics"},{"key":"R34-20250924","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1001\/jama.2014.9743","article-title":"Clinical management of Staphylococcus aureus bacteremia: a review.","volume":"312","author":"Holland","year":"2014","journal-title":"JAMA"},{"key":"R35-20250924","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1111\/j.1469-0691.2006.01589.x","article-title":"Increasing incidence but decreasing in-hospital mortality of adult Staphylococcus aureus bacteraemia between 1981 and 2000.","volume":"13","author":"Benfield","year":"2007","journal-title":"Clin Microbiol Infect"},{"key":"R36-20250924","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/1471-2431-14-121","article-title":"Trends of Staphylococcus aureus bloodstream infections in a neonatal intensive care unit from 2000-2009.","volume":"14","author":"Dolapo","year":"2014","journal-title":"BMC Pediatr"}],"container-title":["Pediatric Infectious Disease Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/INF.0000000000004841","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T20:01:39Z","timestamp":1758744099000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/INF.0000000000004841"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,26]]},"references-count":35,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/inf.0000000000004841","relation":{},"ISSN":["0891-3668","1532-0987"],"issn-type":[{"type":"print","value":"0891-3668"},{"type":"electronic","value":"1532-0987"}],"subject":[],"published":{"date-parts":[[2025,6,26]]}}}