{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:46:48Z","timestamp":1792799208601,"version":"4.5.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T00:00:00Z","timestamp":1617235200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Optimal vancomycin exposure is important to minimize treatment failure of methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> (MRSA) bacteremia. We aimed to analyze the impact of initial vancomycin pharmacokinetic\/pharmacodynamic (PK\/PD) parameters, including the initial vancomycin C <jats:sub>trough<\/jats:sub> and the area under the curve (AUC)\/minimal inhibitory concentration (MIC) on the outcomes of pediatric MRSA bacteremia. The study population consisted of hospitalized children aged between 2 months and 18 years with MRSA bacteremia, in whom C <jats:sub>trough<\/jats:sub> was measured at least one time within the time period of January 2010 to March 2018. Demographic profiles, underlying diseases, and clinical\/microbiological outcomes were abstracted retrospectively. During the study period, 73 cases of MRSA bacteremia occurred in children with a median age of 12.4 months. Severe clinical outcomes leading to intensive care unit stay and\/or use of mechanical ventilation occurred in 47.5% (35\/73); all-cause 30-day mortality was 9.7% (7\/72). The median dosage of vancomycin was 40.0 mg\/kg\/day. There was a weak linear relationship between C <jats:sub>trough<\/jats:sub> and the corresponding AUC\/MIC (<jats:italic>r<\/jats:italic> = 0.235). ROC curves for achieving an AUC\/MIC of 300 suggested that the initial C <jats:sub>trough<\/jats:sub> at 10 \u03bcg\/mL could be used as a cut-off value with a sensitivity of 90.5% and a specificity of 44%. Although persistent bacteremia at 48\u201372 hours after vancomycin administration was observed more frequently when the initial C <jats:sub>trough<\/jats:sub> was &lt; 10 \u03bcg\/mL and initial AUC\/MIC was &lt; 300, initial AUC\/MIC &lt; 300 was the only risk factor associated with persistent bacteremia at 48\u201372 hours (adjusted OR 3.05; 95% CI, 1.07\u20138.68). Initial C <jats:sub>trough<\/jats:sub> and AUC\/MIC were not associated with 30-day mortality. Although there was a weak relationship between C <jats:sub>trough<\/jats:sub> and AUC\/MIC, initial AUC\/MIC &lt; 300 could be used as a predictor of persistent MRSA bacteremia at 48\u201372 hours. Further prospective data on optimal vancomycin dosing are necessary to improve clinical and microbiological outcomes in pediatric MRSA bacteremia.<\/jats:p>","DOI":"10.1371\/journal.pone.0247714","type":"journal-article","created":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T18:38:50Z","timestamp":1617302330000},"page":"e0247714","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Impact of initial vancomycin pharmacokinetic\/pharmacodynamic parameters on the clinical and microbiological outcomes of methicillin-resistant Staphylococcus aureus bacteremia in 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