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Nanomechanics of Drug-target Interactions and Antibacterial Resistance Detection
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Vancomycin drug monitoring in infants with CoNS sepsis-target attainment, microbiological response and nephrotoxicity

Isabelle Viel-Thériault1, Brigitte Martin2, Félix Thompson-Desormeaux2

  • 1Department of Pediatrics, Centre Hospitalier de l'Université Laval, Québec, QC, Canada. Isabelle.viel-theriault.1@ulaval.ca.

Journal of Perinatology : Official Journal of the California Perinatal Association
|October 3, 2019
PubMed

Insights

Most infants achieved targeted vancomycin levels, but persistent coagulase-negative staphylococci (CoNS) sepsis remained common. No specific vancomycin concentration threshold was linked to nephrotoxicity or treatment failure in infants.

Area of Science:

  • Pediatric Infectious Diseases
  • Pharmacokinetics and Pharmacodynamics
  • Neonatal Critical Care

Background:

  • Vancomycin is crucial for treating serious Gram-positive bacterial infections in infants.
  • Monitoring vancomycin trough concentrations (Cmin) is standard practice to optimize efficacy and minimize toxicity.
  • Understanding the relationship between vancomycin Cmin, nephrotoxicity, and treatment outcomes in neonates is essential.

Purpose of the Study:

  • To determine the proportion of infants achieving target vancomycin Cmin (10-20 mg/L).
  • To evaluate the association between vancomycin Cmin and the risk of nephrotoxicity.
  • To assess the relationship between vancomycin Cmin and persistent coagulase-negative staphylococci (CoNS) sepsis.

Main Methods:

  • Retrospective study of 120 infants treated with vancomycin over 5 years.
  • Primary outcome: proportion of infants with steady-state Cmin between 10-20 mg/L.
  • Secondary outcomes: incidence of nephrotoxicity and persistent CoNS sepsis, analyzed in relation to Cmin.

Main Results:

  • Median first steady-state Cmin was 12.4 mg/L; 64% achieved target levels.
  • Six percent of infants developed nephrotoxicity, not significantly associated with Cmin.
  • Of 30 infants with CoNS sepsis, 57% had persistent bacteremia, not correlated with Cmin, MIC, or Cmin/MIC.

Conclusions:

  • The majority of infants achieved therapeutic vancomycin Cmin.
  • Persistent CoNS bacteremia was frequent despite targeted vancomycin levels.
  • No specific Cmin threshold was identified as a predictor for nephrotoxicity or microbiological clearance in this cohort.
Abstract

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