Asset Details
Do you wish to reserve the book?
Limited association between serum vancomycin pharmacokinetic/ pharmacodynamic indices and clinical outcomes in gram-positive complicated urinary tract infections
Hey, we have placed the reservation for you!
By the way, why not check out events that you can attend while you pick your title.
Oops! Something went wrong.
Looks like we were not able to place the reservation. Kindly try again later.
Are you sure you want to remove the book from the shelf?
Limited association between serum vancomycin pharmacokinetic/ pharmacodynamic indices and clinical outcomes in gram-positive complicated urinary tract infections
Do you wish to request the book?
Limited association between serum vancomycin pharmacokinetic/ pharmacodynamic indices and clinical outcomes in gram-positive complicated urinary tract infections
Please be aware that the book you have requested cannot be checked out. If you would like to checkout this book, you can reserve another copy
We have requested the book for you!
Your request is successful and it will be processed during the Library working hours. Please check the status of your request in My Requests.
Oops! Something went wrong.
Looks like we were not able to place your request. Kindly try again later.
Journal Article
Limited association between serum vancomycin pharmacokinetic/ pharmacodynamic indices and clinical outcomes in gram-positive complicated urinary tract infections
2026
Overview
BackgroundVancomycin, primarily excreted through the urine, is used for complicated urinary tract infections (cUTIs) caused by Gram-positive bacteria. Although serum therapeutic drug monitoring (TDM) is usually performed in vancomycin therapy, its benefits and risk factors in patients with cUTIs remain unclear.MethodsAdults with Gram-positive bacterial cUTIs receiving serum vancomycin TDM were enrolled from three prospective, multicenter trials. Minimal inhibitory concentration (MIC) was measured by agar dilution for pathogens collected from all patients. Clinical characteristics and pharmacokinetic/pharmacodynamic (PK/PD) indices were analyzed between the vancomycin treatment success and failure groups.ResultsA total of 74 adult patients with cUTIs were enrolled. Median initial daily dose of vancomycin was 1.0 g (interquartile range [IQR], 1.0–2.0 g), given in divided doses every 12 h or as a once-daily regimen. Most concomitant antibiotics targeted Gram-negative bacteria or fungi, with very limited anti-Gram-positive co-therapy. The median serum trough concentration (Cmin) of vancomycin was 9.22 mg/L (IQR, 4.36–14.33 mg/L) and 24-h area under the concentration-time curve to MIC (AUC24/MIC) was 455 (IQR, 268–627). Despite low attainment of the AUC24/MIC 400–600 target (27/74, 36.5%), the treatment success rate was 86.5% (64/74) and the nephrotoxicity rate was 4.1% (3/74). Urinary pathogens isolated included Enterococcus spp (55/74), Streptococcus spp (10/74), and Staphylococcus aureus (9/74), including eight methicillin-resistant S . aureus [MRSA]). Both solid tumor and S. aureus infection showed exploratory associations with vancomycin treatment failure. Patients with solid tumor had a lower probability of attaining the target AUC24/MIC, likely due to the elevated MIC of the predominant Enterococcus strains in this population. In contrast, patients with S. aureus -induced cUTIs achieved higher AUC24/MIC levels. All isolates exhibited low MICs (≤1 mg/L), no heteroresistance was detected, and the predominant molecular type was clone complex 5 (CC5).ConclusionVancomycin was effective in Enterococcus -dominant cUTIs and had a modest response in a few MRSA cases, despite low PK/PD target attainment. Serum Cmin and AUC24/MIC showed limited association with clinical outcomes, whereas solid tumor and S. aureus infection showed exploratory associations with treatment failure. However, TDM remains valuable for safety monitoring and individualized dosing. These findings should be validated in larger cohorts.
Publisher
Frontiers Media SA,Frontiers Media S.A
