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Background  Vancomycin is commonly used to treat  Enterococcus faecium  ( E. faecium ) bacteremia. However, there are very few studies on the association between the trough concentration, area under the curve from 0 to 24 h /minimum inhibitory concentration (AUC 24 /MIC) ratio, and the therapeutic effect of vancomycin on  E. faecium  bacteremia. This study aimed to investigate the associations between vancomycin pharmacokinetic/pharmacodynamic parameters, patient characteristics, and mortality in patients with  E. faecium  bacteremia .Methods  This retrospective study included patients with  E. faecium  bacteremia who received vancomycin between April 2012 and February 2018 at a single acute care hospital in Japan. Patients who received renal replacement therapy (hemodialysis or continuous hemodiafiltration), had an unmeasured serum vancomycin concentration, with unmeasured laboratory values, or received other antibiotics for treating  E. faecium  bacteremia were excluded from the study. The bivariate associations between 30-day all-cause mortality and patient characteristics were assessed.    Results  Among 87 patients diagnosed with  E. faecium  bacteremia, 45 were included in the final analysis. Of these, 12 (26.7%) died within 30 days of the diagnosis. The vancomycin trough concentration was higher in the 30-day all-cause mortality patients than in the survival patients (20.5 vs. 14.6 μg/mL;  P  = 0.022). There was no significant difference in the proportion of patients with a vancomycin AUC 24 /MIC ≤389 between the groups. The 30-day all-cause mortality patients showed a higher Charlson Comorbidity Index (CCI) and Sequential Organ Failure Assessment score at the first measurement of the vancomycin trough concentration than the survival patients. The same finding was observed among patients with a high CCI score (≥5 points).    Conclusions  Whereas the vancomycin trough concentration and AUC 24 /MIC ratio were not associated with mortality in patients with  E. faecium  bacteremia, disease severity was associated with mortality in these patients.

journal of pharmaceutical health care and sciences

Association between vancomycin pharmacokinetic/pharmacodynamic parameters, patient characteristics, and mortality in patients with bacteremia caused by vancomycin-susceptible Enterococcus faecium: a single-center retrospective study