Evaluation of Vancomycin Use in Late-Onset Neonatal Sepsis Using the Area Under the Concentration-Time Curve to the Minimum Inhibitory Concentration ≥400 Target.

摘要: Aim To develop a vancomycin population pharmacokinetic model and assess the probability of attaining pharmacodynamic target associated with clinical microbiological success, ratio 24-hour area under concentration-time curve to minimum inhibitory concentration (MIC) ≥ 400, in 5-year cohort preterm term neonatal patients late-onset staphylococcal sepsis. Methods Therapeutic drug monitoring data were obtained from septic neonates ≥1 concentration(s) January 2006 September 2011. Only postnatal age >72 hours positive culture included. Population was developed using nonlinear mixed effects modeling (NONMEM 7.2). Eleven demographic characteristics evaluated as covariates. Probabilities achieving evaluated. Results A 1-compartment first-order elimination constructed 528 concentrations collected 152 neonates. Body weight, creatinine clearance (CL), postmenstrual identified significant Estimated CL volume distribution for typical 0.068 ± 0.03 L·h·kg 0.62 0.13 L/kg, respectively. Coagulase-negative staphylococci (85.5%) Staphylococcus aureus (14.5%) common pathogenic organisms. The MIC breakpoints composed approximately 70% breakpoint ≤2 mcg/mL. Approximately 54% neonates, median serum 0.44 mg/dL, achieved 400 daily dose 30 (interquartile range, 21-42) mg/kg. Conclusions CL, significantly influenced CL. current doses are acceptable at MICs ≤1 mcg/mL because they likely achieve majority patients, although higher may be considered more resistant infections.