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-
1
National Nosocomial Infections Surveillance System: National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32: 470, 2004.
-
2
Streit JM, Jones RN, Sader HS, et al: Assessment of pathogen occurrences and resistance profiles among infected patients in the intensive care unit: report from the SENTRY antimicrobial surveillance program (North America, 2001). Int J Antimicrob Agents 24: 111, 2004.
-
3
Naimi TS, LeDell KH, Como-Sabetti K, et al: Comparison of community- and health care–associated methicillin-resistant Staphylococcus aureus infection. JAMA 290: 2976, 2003.
-
4
Ochoa TJ, Mohr J, Wanger A, et al: Community-associated methicillin-resistant Staphylococcus aureus in pediatric patients. Emerg Infect Dis 11: 966, 2005.
-
5
Moran GJ, Amii RN, Abrahamian FM, et al: Methicillin-resistant Staphylococcus aureus in community-acquired infections. Emerg Infect Dis 11: 928, 2005.
-
6
Rybak M, Lomaestro B, Rotschafer JC, et al: Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 66: 82, 2009.
-
7
Lodise TP, Patel N, Lomaestro BM, et al: Relationship between initial vancomycin concentration-time profile and nephrotoxicity among hospitalized patients. Clin Infect Dis 49: 507, 2009.
-
8
Lodise TP, Lomaestro B, Graves J, et al: Larger vancomycin doses (at least four grams per day) are associated with an increased incidence of nephrotoxicity. Antimicrob Agents Chemother 52: 1330, 2008.
-
9
Whitener CJ, Park SY, Browne FA, et al: Vancomycin-resistant Staphylococcus aureus in the absence of vancomycin exposure. Clin Infect Dis 38: 1049, 2004.
-
10
Appelbaum PC: Reduced glycopeptide susceptibility in methicillin-resistant Staphylococcus aureus (MRSA). Int J Antimicrob Agents 30: 398, 2007.
-
11
Lodise TP, Graves J, Evans A, et al: Relationship between vancomycin MIC and failure among patients with methicillin-resistant Staphylococcus aureus bacteremia treated with vancomycin. Antimicrob Agents Chemother 52: 3315, 2008.
-
12
Payne CJ, Thomson AH, Stearns AT, et al: Pharmacokinetics and tissue penetration of vancomycin continuous infusion as prophylaxis for vascular surgery. J Antimicrob Chemother 66: 2624, 2011.
-
13
Skhirtladze K, Hutschala D, Fleck T, et al: Impaired target site penetration of vancomycin in diabetic patients following cardiac surgery. Antimicrob Agents Chemother 50: 1372, 2006.
-
14
Lodise TP, Drusano GL, Butterfield JM, et al: Penetration of vancomycin into epithelial lining fluid in healthy volunteers. Antimicrob Agents Chemother 55: 5507, 2011.
-
15
Ricard JD, Wolff M, Lacherade JC, et al: Levels of vancomycin in cerebrospinal fluid of adult patients receiving adjunctive corticosteroids to treat pneumococcal meningitis: a prospective multicenter observational study. Clin Infect Dis 44: 250, 2007.
-
16
Lipsky BA, Berendt AR, Cornia PB, et al: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. JAPMA 103: 2, 2013.
-
17
Kim A, Suecof LA, Sutherland CA, et al: In vivo microdialysis study of the penetration of daptomycin into soft tissues in diabetic versus healthy volunteers. Antimicrob Agents Chemother 52: 3941, 2008.
-
18
Bulik CC, Wiskirchen DE, Shepard A, et al: Tissue penetration and pharmacokinetics of tigecycline in diabetic patients with chronic wound infections described by using in vivo microdialysis. Antimicrob Agents Chemother 54: 5209, 2010.
-
19
Sahre M, Sabarinath S, Grant M, et al: Skin and soft tissue concentrations of tedizolid (formerly torezolid), a novel oxazolidinone, following a single oral dose in healthy volunteers. Int J Antimicrob Agents 40: 51, 2012.
-
20
Hagihara M, Sutherland C, Nicolau DP: Development of HPLC methods for the determination of vancomycin in human plasma, mouse serum and bronchoalveolar lavage fluid. J Chromatogr Sci 51: 201, 2013.
-
21
MacVane SH, Housman ST, Nicolau DP: Assessing the impact of combination antibiotic therapy on in vitro microdialysis recoveries. Paper presented at: 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy; September 10-13, 2013; Denver, CO. Abstract F-1700.
-
22
Farrell DJ, Castanheira M, Mendes RE, et al: In vitro activity of ceftaroline against multidrug-resistant Staphylococcus aureus and Streptococcus pneumoniae: a review of published studies and the AWARE Surveillance Program (2008-2010). Clin Infect Dis 55 (suppl 3): S206, 2012.
-
23
Joukhadar C, Muller M: Microdialysis: current applications in clinical pharmacokinetic studies and its potential role in the future. Clin Pharmacokinet 44: 895, 2005.
-
24
Crandon JL, MacVane SH, Nicolau DP: Clinical laboratory based assay methodologies may underestimate and increase variability of vancomycin protein binding in patients. Pharmacotherapy 34: 203, 2014.
-
25
Keel RA, Crandon JL, Nicolau DP: Pharmacokinetics and pulmonary disposition of tedizolid and linezolid in a murine pneumonia model under variable conditions. Antimicrob Agents Chemother 56: 3420, 2012.
-
26
Kuti JL, Nicolau DP: Levofloxacin penetration into epithelial lining fluid differs between infected and uninfected patients. Paper presented at: 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy; September 9-12, 2012; San Francisco, CA. Abstract A-1964.
Vancomycin Tissue Pharmacokinetics in Patients with Lower-Limb Infections via In Vivo Microdialysis
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Background
Vancomycin is a common treatment option for skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Given the increasing prevalence of MRSA, vancomycin is widely used as empirical therapy. In patients with lower-limb infections, antimicrobial penetration is often reduced because of decreased vascular perfusion. In this study, we evaluated the tissue concentrations of vancomycin in hospitalized patients with lower-limb infections.
Methods
An in vivo microdialysis catheter was inserted near the margin of the wound and was perfused with lactated Ringer's solution. Tissue and serum samples were obtained after steady state for one dosing interval. Tissue concentrations were corrected for percentage of in vivo recovery using the retrodialysis technique.
Results
Nine patients were enrolled (mean ± SD: age, 54 ± 19 years; weight, 105.6 ± 31.5 kg). Patients received a mean of 12.8 mg/kg of vancomycin every 12 hours (n = 7), every 8 hours (n = 1), or every 24 hours (n = 1). Mean ± SD steady-state trough vancomycin concentrations in serum and tissue were 11.1 ± 3.3 and 6.0 ± 2.6 μg/mL. The mean ± SD 24-hour free drug areas under the curve for serum and wound were 283.7 ± 89.4 and 232.8 ± 75.7 μg*h/mL, respectively. The mean ± SD tissue penetration ratio was 0.8 ± 0.2.
Conclusions
These data suggest that against MRSA with minimum inhibitory concentrations of 1 μg/mL or less, vancomycin achieved blood pharmacodynamic targets required for the likelihood of success. Reduced concentrations may contribute to poor outcomes and the development of resistance. As other literature suggests, alternative agents may be needed when the pathogen of interest has a minimum inhibitory concentration greater than 1 μg/mL.
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