Age-Related Differences in Vancomycin-Associated Nephrotoxicity and Efficacy in Methicillin-Resistant Staphylococcus aureus Infection: A Comparative Study between Elderly and Adult Patients

肾毒性 医学 万古霉素 肾功能 内科学 入射(几何) 耐甲氧西林金黄色葡萄球菌 金黄色葡萄球菌 胃肠病学 毒性 生物 细菌 遗传学 物理 光学
作者
Xi Lin,Shanshan Li,Mengting Chen,Xiaolan Huang,Nanyang Li,Nanye Chen,Hailan Wu,Qiyu Bian,Xingchen Bian,Xin Li,Minjie Yang,Xiaoyu Liang,Jufang Wu,Beining Guo,Yaxin Fan,Jing Zhang
出处
期刊:Antibiotics [Multidisciplinary Digital Publishing Institute]
卷期号:13 (4): 324-324 被引量:4
标识
DOI:10.3390/antibiotics13040324
摘要

Elderly patients (age ≥ 65 years) are susceptible to methicillin-resistant Staphylococcus aureus (MRSA) infections, with potential for more adverse treatment outcomes or complications compared to younger adults (18–64 years). This study compared vancomycin-associated nephrotoxicity and efficacy in elderly and adult patients and investigated the correlation between vancomycin pharmacokinetic/pharmacodynamic (PK/PD) indices and clinical outcomes. A prospective study was conducted in 10 hospitals in Shanghai from October 2012 to November 2019. A total of 164 patients with MRSA infections were enrolled, including 83 elderly and 81 adult patients. Vancomycin therapeutic drug monitoring (TDM) was performed in all patients, indicating significantly higher vancomycin trough concentrations (Ctrough), 24-h area under the curve (AUC24) values, and AUC24/minimum inhibitory concentration (AUC24/MIC) values in elderly patients compared to adult patients. The incidence of vancomycin-associated nephrotoxicity was nearly three times higher in elderly patients (18.1% vs. 6.2%, p = 0.020), despite similar clinical and microbiological efficacy. Of particular importance, a Ctrough > 20 mg/L was found as an independent factor of nephrotoxicity in elderly patients. Further analysis of patients with an estimated glomerular filtration rate (eGFR) > 60 mL/min/1.73 m2 also revealed that elderly patients had significantly higher vancomycin-related PK/PD indices and more nephrotoxicity than adult patients. In conclusion, elderly patients receiving vancomycin therapy face a higher risk of nephrotoxicity, which requires close vancomycin TDM, especially when the Ctrough exceeds 20 mg/L.
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