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Discrepancy in Vancomycin AUC/MIC Ratio Targeted Attainment Based upon the Susceptibility Testing in Staphylococcus

Seenae Eum1, Robert L Bergsbaken2, Craig L Harvey3

  • 1Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA. eumxx005@umn.edu.

Antibiotics (Basel, Switzerland)
|October 1, 2016
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Summary

Vancomycin minimum inhibitory concentration (MIC) testing for Staphylococcus aureus bloodstream infections showed significant differences between Vitek 2 and E-test methods. Achieving guideline targets required higher vancomycin exposure with E-test MICs compared to Vitek 2 MICs.

Keywords:
MICStaphylococcus aureussusceptibility testingvancomycin

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Area of Science:

  • Clinical Microbiology
  • Pharmacokinetics and Pharmacodynamics
  • Infectious Diseases

Background:

  • Accurate vancomycin minimum inhibitory concentration (MIC) determination is crucial for optimizing treatment of Staphylococcus aureus infections.
  • Discrepancies in MIC testing methods can impact therapeutic outcomes and guideline adherence.
  • The Infectious Diseases Society of America (IDSA), American Society of Health System Pharmacists (ASHP), and Society of Infectious Diseases Pharmacists (SIDP) provide guidelines for vancomycin therapy.

Purpose of the Study:

  • To compare vancomycin MIC values for Staphylococcus aureus determined by the Vitek 2 automated system and the E-test method.
  • To evaluate the impact of differing MIC results on achieving pharmacokinetic/pharmacodynamic (PK/PD) targets in S. aureus bloodstream infections.

Main Methods:

  • Retrospective analysis of vancomycin MICs for S. aureus bloodstream isolates using Vitek 2 and E-test.
  • Calculation of target attainment based on area under the serum concentration time curve (AUC) to MIC ratio (AUC/MIC).
  • Statistical comparison of target attainment rates between the two MIC testing methods.

Main Results:

  • A statistically significant difference was observed in vancomycin MICs between Vitek 2 and E-test (p < 0.0001).
  • Using Vitek 2 MICs, nearly 100% target attainment was achieved at an AUC threshold of 400 mg∙h/L, compared to only 40% with E-test MICs.
  • An AUC of 450 mg∙h/L or greater was necessary to achieve 100% target attainment regardless of the MIC testing method.

Conclusions:

  • The choice of vancomycin MIC testing method (Vitek 2 vs. E-test) significantly influences the assessment of target attainment in S. aureus bloodstream infections.
  • E-test may underestimate vancomycin susceptibility, potentially leading to suboptimal dosing strategies.
  • Clinical laboratories and clinicians should be aware of method-dependent discrepancies in vancomycin MICs to ensure effective patient management.