Vancomycin serum concentrations in pediatric oncologic/hematologic intensive care patients

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dc.contributor.authorSilva, Dáfne Cardoso Bourguignon da [UNIFESP]
dc.contributor.authorSeixas, Gláucia Toribio Finoti [UNIFESP]
dc.contributor.authorAraujo, Orlei Ribeiro de [UNIFESP]
dc.contributor.authorArduini, Rodrigo Genaro [UNIFESP]
dc.contributor.authorCarlesse, Fabianne Altruda de Moraes Costa [UNIFESP]
dc.contributor.authorPetrilli, Antonio Sergio [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2015-06-14T13:44:53Z
dc.date.available2015-06-14T13:44:53Z
dc.date.issued2012-08-01
dc.description.abstractBACKGROUND: Usual treatment regimens with vancomycin often fail to provide adequate serum levels in patients with severe infections. METHODS: Retrospective analysis of vancomycin trough serum measurements. The following parameters were calculated by Bayesian analysis: vancomycin clearance, distribution volume, and peak estimated concentrations. The area under the concentration curve (AUC) (total daily dose/24 h clearance of vancomycin) was used to determine the effectiveness of treatment through the ratio of AUC/minimum inhibitory concentration (MIC) above 400, using MIC = 1 µg/mL, based on isolates of Staphylococci in cultures. RESULTS: Sixty-one vancomycin trough measurements were analyzed in 31 patients. AUC/MIC > 400 was obtained in 34 out of 61 dosages (55.7%), but the mean vancomycin dose required to achieve these levels was 81 mg/kg/day. In cases where the usual doses were administered (40-60 mg/kg/day), AUC/MIC > 400 was obtained in nine out of 18 dosages (50%), in 13 patients. Trough serum concentrations above 15 mg/L presented a positive predictive value of 100% and a negative predictive value of 71% for AUC/MIC > 400. CONCLUSION: Higher than usual vancomycin doses may be required to treat staphylococcal infections in children with oncologic/hematologic diseases. Since the best known predictor of efficacy is the AUC/MIC ratio, serum trough concentrations must be analyzed in conjunction with MICs of prevalent Staphylococci and pharmacokinetic tools such as Bayesian analysis.en
dc.description.affiliationUniversidade Federal de São Paulo (UNIFESP) Grupo de Apoio ao Adolescente e a Criança com Câncer Instituto de Oncologia Pediátrica
dc.description.affiliationUNIFESP GRAACC IOP
dc.description.affiliationUniversidade Federal de São Paulo (UNIFESP) Department of Pediatrics
dc.description.affiliationUnifespUNIFESP, Grupo de Apoio ao Adolescente e a Criança com Câncer Instituto de Oncologia Pediátrica
dc.description.affiliationUnifespUNIFESP, GRAACC IOP
dc.description.affiliationUnifespUNIFESP, Department of Pediatrics
dc.description.sourceSciELO
dc.format.extent361-365
dc.identifierhttp://dx.doi.org/10.1016/j.bjid.2012.06.011
dc.identifier.citationBrazilian Journal of Infectious Diseases. Brazilian Society of Infectious Diseases, v. 16, n. 4, p. 361-365, 2012.
dc.identifier.doi10.1016/j.bjid.2012.06.011
dc.identifier.fileS1413-86702012000400009.pdf
dc.identifier.issn1413-8670
dc.identifier.scieloS1413-86702012000400009
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/7249
dc.identifier.wosWOS:000307527400009
dc.language.isoeng
dc.publisherBrazilian Society of Infectious Diseases
dc.relation.ispartofBrazilian Journal of Infectious Diseases
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectImmunosuppressionen
dc.subjectDrug resistanceen
dc.subjectMicrobialen
dc.subjectStaphylococcusen
dc.subjectAnti-bacterial agentsen
dc.subjectPharmacokineticsen
dc.titleVancomycin serum concentrations in pediatric oncologic/hematologic intensive care patientsen
dc.typeinfo:eu-repo/semantics/article
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