{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T01:35:29Z","timestamp":1788831329099,"version":"build-2803163510"},"reference-count":0,"publisher":"Canadian Society of Healthcare-Systems Pharmacy","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJHP"],"abstract":"<jats:p>Background: Vancomycin remains widely used for methicillin-resistant Staphylococcus aureus (MRSA) infections; however, treatment failure rates up to 50% have been reported. At the authors\u2019 institution, monitoring of trough concentration is the standard of care for therapeutic drug monitoring of vancomycin. New guidelines support use of the ratio of 24-hour area under the concentration\u2013time curve to minimum inhibitory concentration (AUC24\/MIC) as the pharmacodynamic index most likely to predict outcomes in patients with MRSA-associated infections.Objectives: To determine the discordance rate between trough levels and AUC24\/MIC values and how treatment failure and nephrotoxicity outcomes compare between those achieving and not achieving their pharmacodynamic targets.\nMethods: This retrospective cohort study involved patients with MRSA bacteremia or pneumonia admitted to the study hospital between March 1, 2014, and December 31, 2018, and treated with vancomycin. Data for trough concentrations were collected, and minimum concentrations (Cmin) were extrapolated. The AUC24\/MIC values were determined using validated population pharmacokinetic models. The Cmin and AUC24\/MIC values were characterized as below, within, or above pharmacodynamic targets (15\u201320 mg\/L and 400\u2013600, respectively). Discordance was defined as any instance where a patient\u2019s paired Cmin and AUC24\/MIC values fell in different ranges (i.e., below, within, or above) relative to the target ranges. Predictors of treatment failure and nephrotoxicity were determined using logistic regression.\nResults: A total of 128 patients were included in the analyses. Of these, 73 (57%) received an initial vancomycin dose less than 15 mg\/kg. The discordance rate between Cmin and AUC24\/MIC values was 21% (27\/128). Rates of treatment failure and nephrotoxicity were 34% (43\/128) and 18% (23\/128), respectively. No clinical variables were found to predict discordance. Logistic regression identified initiation of vancomycin after a positive culture result (odds ratio [OR] 4.41, 95% confidence interval [CI] 1.36\u201314.3) and achievement of target AUC24\/MIC after 4 days (OR 3.48, 95% CI 1.39\u20138.70) as modifiable predictors of treatment failure.\nConclusions: The relationship between vancomycin monitoring and outcome is likely confounded by inadequate empiric or initial dosing. Before any modification of practice with respect to vancomycin monitoring, empiric vancomycin dosing should be optimized.\u00a0\nR\u00c9SUM\u00c9\nContexte : La vancomycine reste largement utilis\u00e9e contre les infections dues au Staphylococcus aureus m\u00e9thicillinor\u00e9sistant (SAMR); cependant, on rapporte des taux d\u2019\u00e9chec de traitement allant jusqu\u2019\u00e0 50 %. Dans l\u2019institution o\u00f9 travaillent les auteurs, la surveillance de la concentration minimale constitue la norme de soins du suivi th\u00e9rapeutique pharmacologique de la vancomycine. De nouvelles lignes directrices soutiennent l\u2019utilisation du ratio de 24 h de l\u2019aire sous la courbe de concentration-temps \u00e0 concentration minimale inhibitrice (AUC24\/MIC) en tant qu\u2019indice pharmacodynamique, vraisemblablement pour pr\u00e9dire certains r\u00e9sultats concernant les patients pr\u00e9sentant des infections associ\u00e9es au SAMR.\nObjectifs : D\u00e9terminer le taux de discordance entre la concentration minimale et les valeurs de l\u2019AUC24\/MIC et la mani\u00e8re dont les \u00e9checs de traitement et les r\u00e9sultats de n\u00e9phrotoxicit\u00e9 se comparent entre les personnes atteignant leurs cibles pharmacodynamiques et celles qui ne l\u2019atteignent pas.\nM\u00e9thodes : Cette \u00e9tude de cohorte r\u00e9trospective impliquait des patients atteints d\u2019une bact\u00e9ri\u00e9mie au SAMR ou d\u2019une pneumonie au SAMR, admis \u00e0 l\u2019h\u00f4pital o\u00f9 se d\u00e9roulait l\u2019\u00e9tude entre le 1er mars 2014 et le 31 d\u00e9cembre 2018 et trait\u00e9s \u00e0 l\u2019aide de vancomycine. Les donn\u00e9es relatives aux concentrations minimales ont \u00e9t\u00e9 recueillies, et les concentrations minimales (Cmin) extrapol\u00e9es. Les valeurs de l\u2019AUC24\/MIC ont \u00e9t\u00e9 d\u00e9termin\u00e9es \u00e0 l\u2019aide de mod\u00e8les de population pharmacocin\u00e9tiques valid\u00e9s. La caract\u00e9risation des valeurs de la Cmin et des valeurs de l\u2019AUC24\/MIC se d\u00e9crit comme suit : \u00ab en dessous \u00bb, \u00ab \u00e0 l\u2019int\u00e9rieur \u00bb ou \u00ab au-dessus \u00bb des cibles pharmacodynamiques (respectivement 15-20 mg\/L et 400-600). La discordance \u00e9tait d\u00e9finie comme une situation o\u00f9 les valeurs associ\u00e9es de la Cmin et de l\u2019AUC24\/MIC tombaient dans des plages diff\u00e9rentes (c.-\u00e0-d., en dessous, \u00e0 l\u2019int\u00e9rieur ou au-dessus) par rapport aux plages cibles. Une r\u00e9gression logistique a permis de d\u00e9terminer les pr\u00e9dicteurs d\u2019\u00e9checs de traitement et de n\u00e9phrotoxicit\u00e9.\nR\u00e9sultats : Au total, 128 patients ont \u00e9t\u00e9 inclus dans les analyses. De ceux-ci, 73 (57 %) ont re\u00e7u une dose initiale de vancomycine de moins de 15 mg\/kg. Le taux de discordance entre les valeurs de la Cmin et de l\u2019AUC24\/MIC \u00e9tait de 21 % (27\/128). Les taux d\u2019\u00e9chec de traitement et de n\u00e9phrotoxicit\u00e9 se montaient respectivement \u00e0 34 % (43\/128) et 18 % (23\/128). Aucune variable clinique n\u2019a pu pr\u00e9dire la discordance. La r\u00e9gression logistique a permis de d\u00e9terminer le d\u00e9but de l\u2019administration de la vancomycine apr\u00e8s un r\u00e9sultat de culture positif (rapport de cotes [RC] 4,41, 95 % intervalle de confiance [IC] 1,36\u201314,3) et l\u2019atteinte de la cible de l\u2019AUC24\/MIC apr\u00e8s quatre jours (RC 3,48, 95 % IC 1,39-8,70) en tant que pr\u00e9dicteurs modifiables de l\u2019\u00e9chec du traitement.\nConclusions : Il existe probablement une confusion relative \u00e0 la relation entre la surveillance de la vancomycine et le r\u00e9sultat \u00e0 cause d\u2019un dosage empirique ou initial inad\u00e9quat. Avant de modifier la pratique relative \u00e0 la surveillance de la vancomycine, le pharmacien doit optimiser son dosage empirique.<\/jats:p>","DOI":"10.4212\/cjhp.v74i4.3195","type":"journal-article","created":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T04:42:23Z","timestamp":1633840943000},"source":"Crossref","is-referenced-by-count":6,"title":["Therapeutic Drug Monitoring of Vancomycin in Adult Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia or Pneumonia"],"prefix":"10.4212","volume":"74","author":[{"given":"Ryan","family":"Marko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Hajjar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Nzeribe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Pittman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Deslandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Sant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juthaporn","family":"Cowan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwadwo","family":"Kyermentang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Ramsay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheryl","family":"Zelenitsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salmaan","family":"Kanji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2732","published-online":{"date-parts":[[2021,9,28]]},"container-title":["Canadian Journal of Hospital Pharmacy"],"original-title":[],"link":[{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3195\/4527","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3195\/4529","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3195\/4545","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3195\/4527","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T04:42:24Z","timestamp":1633840944000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/view\/3195"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,28]]},"references-count":0,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,9,28]]}},"URL":"https:\/\/doi.org\/10.4212\/cjhp.v74i4.3195","relation":{},"ISSN":["1920-2903","0008-4123"],"issn-type":[{"value":"1920-2903","type":"electronic"},{"value":"0008-4123","type":"print"}],"subject":[],"published":{"date-parts":[[2021,9,28]]}}}