2023 年 49 巻 4 号 p. 143-152
The vancomycin (VCM) treatment plan for patients with Enterococcus faecium (E. faecium) infection is based on the recommended dose for methicillin-resistant Staphylococcus aureus (MRSA) infection. However, the optimal dose of VCM for E. faecium infection remains unclear. Thus, this study evaluated the relationship between pharmacokinetics/ pharmacodynamics of vancomycin and clinical outcomes in E. faecium bloodstream infection based on the area under the concentration-time curve/minimum inhibitory concentration (AUC/MIC) ratio. We retrospectively reviewed the records of 40 patients with bloodstream infections caused by E. faecium at Fukuoka University Hospital between 2010 and 2020. The efficacy of VCM was evaluated in terms of clinical findings, laboratory data, and bacterial culture test results. The AUC was estimated using the trough concentration of VCM in TDM analysis software. The incident rate of acute kidney injury (AKI) associated with VCM was evaluated based on Kidney Disease: Improving Global Outcome criteria. The improvement rate was higher in patients with AUC/MIC ≥ 400 µg･h/mL than in those with AUC/MIC < 400 µg･h/mL; 90.9％ (30/33) vs 57.1％ (4/7), P = 0.055, Fisher's exact test. Moreover, we found that when AUC/MIC increased in stages, the improvement rate increased (57.1％ in 300 - 399, 85.7％ in 400 - 499, 92.9％ in 500 - 599, 100.0％ in 600 - 699, 100.0％ in 700 - 799; P = 0.036, Cochran-Armitage trend test). However, all patients with AUC/MIC ≥ 700 µg･h/mL experienced AKI. These results indicate that the effective range of AUC/MIC for E. faecium is ≥ 400 µg･h/mL, and the optimal dose of VCM may be similar to that for MRSA infections.
