Pharmacodynamics of vancomycin in elderly patients aged 75 years or older with methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia

Fumihiro Mizokami,1 Masataka Shibasaki,2 Yasunori Yoshizue,1 Takeshi Noro,1 Tomohiro Mizuno,3 Katsunori Furuta41Department of Pharmacy, 2Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, 3Department of Analytical Pharmacology, Meijo University Graduate School o...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Mizokami F, Shibasaki M, Yoshizue Y, Noro T, Mizuno T, Furuta K
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Methicillin-resistant Staphylococcus aureus elderly patients vancomycin pharmacokinetics pharmacodynamics Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/730b3e604c68422da79b55c1eeccb556
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:730b3e604c68422da79b55c1eeccb556
record_format	dspace
spelling	oai:doaj.org-article:730b3e604c68422da79b55c1eeccb5562021-12-02T03:43:59ZPharmacodynamics of vancomycin in elderly patients aged 75 years or older with methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia1178-1998https://doaj.org/article/730b3e604c68422da79b55c1eeccb5562013-08-01T00:00:00Zhttps://www.dovepress.com/pharmacodynamics-of-vancomycin-in-elderly-patients-aged-75-years-or-ol-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Fumihiro Mizokami,1 Masataka Shibasaki,2 Yasunori Yoshizue,1 Takeshi Noro,1 Tomohiro Mizuno,3 Katsunori Furuta41Department of Pharmacy, 2Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, 3Department of Analytical Pharmacology, Meijo University Graduate School of Pharmacy, Nagoya, 4Department of Clinical Research and Development, National Center for Geriatrics and Gerontology, Obu, JapanBackground: Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with significant mortality and health care costs. To improve treatment outcomes for MRSA, a better understanding of the pharmacokinetic/pharmacodynamic parameters of vancomycin is required to develop optimal dosing strategies, particularly in elderly patients (≥75 years of age) with limited renal function. The purpose of this study was to determine whether pharmacokinetic indices for vancomycin are associated with mortality from MRSA hospital-acquired pneumonia in elderly patients.Methods: We conducted a retrospective observational study with 28-day mortality as the primary outcome for 94 patients with MRSA hospital-acquired pneumonia who had been treated with vancomycin from January 2006 through December 2012. Our most recent sampling of MRSA isolates had a minimum inhibitory concentration (MIC) for vancomycin of 1 µg/mL (86%), indicating that the area under the curve (AUC) was equal to the AUC/MIC in these isolates. The primary data from 28-day survivors and nonsurvivors were compared.Results: Among 94 elderly patients, the mean age was 82 (75–99) years. Multivariate analyses revealed that, among the factors examined, only the nonoptimal AUC (<250, >450 µgh/mL) was an independent predictor of 28-day mortality in elderly patients (odds ratio 23.156, 95% confidence interval 6.814–78.687, P < 0.001). We detected a significant difference for increasing nephrotoxicity in nonsurvivors (nine of 32 patients [28%]) compared with survivors (three of 62 patients [4.8%], P = 0.003).Conclusion: This finding indicates that patients with potentially poor renal function are likely to have increased AUC values and a poor prognosis. Consideration of the pharmacokinetics/pharmacodynamics of vancomycin and targeting an AUC/MIC value of 250–450 µgh/mL may result in improved treatment outcomes for elderly patients with MRSA hospital-acquired pneumonia.Keywords: methicillin-resistant Staphylococcus aureus, elderly patients, vancomycin, pharmacokinetics, pharmacodynamicsMizokami FShibasaki MYoshizue YNoro TMizuno TFuruta KDove Medical PressarticleMethicillin-resistant Staphylococcus aureuselderly patientsvancomycinpharmacokineticspharmacodynamicsGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 8, Pp 1015-1021 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Methicillin-resistant Staphylococcus aureus elderly patients vancomycin pharmacokinetics pharmacodynamics Geriatrics RC952-954.6
spellingShingle	Methicillin-resistant Staphylococcus aureus elderly patients vancomycin pharmacokinetics pharmacodynamics Geriatrics RC952-954.6 Mizokami F Shibasaki M Yoshizue Y Noro T Mizuno T Furuta K Pharmacodynamics of vancomycin in elderly patients aged 75 years or older with methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia
description	Fumihiro Mizokami,1 Masataka Shibasaki,2 Yasunori Yoshizue,1 Takeshi Noro,1 Tomohiro Mizuno,3 Katsunori Furuta41Department of Pharmacy, 2Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, 3Department of Analytical Pharmacology, Meijo University Graduate School of Pharmacy, Nagoya, 4Department of Clinical Research and Development, National Center for Geriatrics and Gerontology, Obu, JapanBackground: Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with significant mortality and health care costs. To improve treatment outcomes for MRSA, a better understanding of the pharmacokinetic/pharmacodynamic parameters of vancomycin is required to develop optimal dosing strategies, particularly in elderly patients (≥75 years of age) with limited renal function. The purpose of this study was to determine whether pharmacokinetic indices for vancomycin are associated with mortality from MRSA hospital-acquired pneumonia in elderly patients.Methods: We conducted a retrospective observational study with 28-day mortality as the primary outcome for 94 patients with MRSA hospital-acquired pneumonia who had been treated with vancomycin from January 2006 through December 2012. Our most recent sampling of MRSA isolates had a minimum inhibitory concentration (MIC) for vancomycin of 1 µg/mL (86%), indicating that the area under the curve (AUC) was equal to the AUC/MIC in these isolates. The primary data from 28-day survivors and nonsurvivors were compared.Results: Among 94 elderly patients, the mean age was 82 (75–99) years. Multivariate analyses revealed that, among the factors examined, only the nonoptimal AUC (<250, >450 µgh/mL) was an independent predictor of 28-day mortality in elderly patients (odds ratio 23.156, 95% confidence interval 6.814–78.687, P < 0.001). We detected a significant difference for increasing nephrotoxicity in nonsurvivors (nine of 32 patients [28%]) compared with survivors (three of 62 patients [4.8%], P = 0.003).Conclusion: This finding indicates that patients with potentially poor renal function are likely to have increased AUC values and a poor prognosis. Consideration of the pharmacokinetics/pharmacodynamics of vancomycin and targeting an AUC/MIC value of 250–450 µgh/mL may result in improved treatment outcomes for elderly patients with MRSA hospital-acquired pneumonia.Keywords: methicillin-resistant Staphylococcus aureus, elderly patients, vancomycin, pharmacokinetics, pharmacodynamics
format	article
author	Mizokami F Shibasaki M Yoshizue Y Noro T Mizuno T Furuta K
author_facet	Mizokami F Shibasaki M Yoshizue Y Noro T Mizuno T Furuta K
author_sort	Mizokami F
title	Pharmacodynamics of vancomycin in elderly patients aged 75 years or older with methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia
title_short	Pharmacodynamics of vancomycin in elderly patients aged 75 years or older with methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia
title_full	Pharmacodynamics of vancomycin in elderly patients aged 75 years or older with methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia
title_fullStr	Pharmacodynamics of vancomycin in elderly patients aged 75 years or older with methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia
title_full_unstemmed	Pharmacodynamics of vancomycin in elderly patients aged 75 years or older with methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia
title_sort	pharmacodynamics of vancomycin in elderly patients aged 75 years or older with methicillin-resistant staphylococcus aureus hospital-acquired pneumonia
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/730b3e604c68422da79b55c1eeccb556
work_keys_str_mv	AT mizokamif pharmacodynamicsofvancomycininelderlypatientsaged75yearsorolderwithmethicillinresistantstaphylococcusaureushospitalacquiredpneumonia AT shibasakim pharmacodynamicsofvancomycininelderlypatientsaged75yearsorolderwithmethicillinresistantstaphylococcusaureushospitalacquiredpneumonia AT yoshizuey pharmacodynamicsofvancomycininelderlypatientsaged75yearsorolderwithmethicillinresistantstaphylococcusaureushospitalacquiredpneumonia AT norot pharmacodynamicsofvancomycininelderlypatientsaged75yearsorolderwithmethicillinresistantstaphylococcusaureushospitalacquiredpneumonia AT mizunot pharmacodynamicsofvancomycininelderlypatientsaged75yearsorolderwithmethicillinresistantstaphylococcusaureushospitalacquiredpneumonia AT furutak pharmacodynamicsofvancomycininelderlypatientsaged75yearsorolderwithmethicillinresistantstaphylococcusaureushospitalacquiredpneumonia
_version_	1718401633580220416

Pharmacodynamics of vancomycin in elderly patients aged 75 years or older with methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia

Ejemplares similares