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Updated: May 15, 2026
11:28
A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically
Published on: September 9, 2015
Evaluation of the relationship between elevated vancomycin trough concentrations and increased efficacy and/or
Bruce H Ackerman1, Robert E Guilday, Cynthia L Reigart
1Nathan Speare Regional Burn Treatment Center, Crozer-Chester Medical Center, Upland, Pennsylvania 19013, USA. Bruce.ackerman@crozer.org
Summary
Higher vancomycin trough concentrations may not improve treatment success for Gram-positive infections, especially in burn patients. Vancomycin nephrotoxicity risk is linked to treatment duration, not necessarily higher trough levels.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Staphylococcus aureus infections often require vancomycin therapy.
- Increasing minimum inhibitory concentrations (MICs) of Staphylococcus aureus suggest a need for higher vancomycin trough concentrations.
- Vancomycin trough levels are monitored to ensure efficacy and minimize toxicity.
Purpose of the Study:
- To evaluate the relationship between vancomycin trough concentrations and treatment efficacy/toxicity.
- To determine if higher vancomycin trough concentrations improve outcomes in patients with suspected or actual Gram-positive infections.
- To assess the impact of vancomycin trough levels on clinical recovery parameters in burn patients.
Main Methods:
- Retrospective analysis of 604 vancomycin treatment courses from 560 patients.
- Stratification of vancomycin trough concentrations into <5, 5-10, and >10 mg/L groups.
- Evaluation of clinical outcomes including time to normal temperature, white blood cell count, and heart rate.
Main Results:
- No significant relationship was demonstrated between vancomycin trough concentration strata and treatment response parameters (p > .05).
- Vancomycin nephrotoxicity risk was primarily correlated with the duration of vancomycin treatment.
- Higher vancomycin trough concentrations did not show a clear benefit in thermal injury patients with burns <20% TBSA.
Conclusions:
- Elevated vancomycin trough concentrations do not guarantee treatment success.
- There may be no significant clinical benefit from increasing vancomycin trough concentrations beyond certain levels.
- Treatment duration is a critical factor in vancomycin-induced nephrotoxicity.
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