Association of vancomycin trough concentration on the treatment outcome of patients with bacteremia caused by Enterococcus species.

BACKGROUND: Pharmacokinetic-pharmacodynamic (PK/PD) targets of vancomycin therapy have been recognized for methicillin-resistant Staphylococcus aureus infections but not for other gram-positive bacterial infections. Therefore, we investigated whether vancomycin concentration targets such as the trough level and ratio of the area under the curve to minimum inhibitory concentration (AUC/MIC) are associated with the treatment outcome in enterococcal bacteremia. METHODS: A retrospective cohort analysis enrolled patients with bacteremia caused by vancomycin-susceptible Enterococcus faecium and Enterococcus faecalis who were treated with vancomycin from January 2007 to December 2017 at a tertiary hospital located in Seoul, South Korea. Patients without vancomycin concentrations were excluded from the study. The primary outcome was 28-day all-cause mortality. RESULTS: A total of 37 patients were enrolled-26 with E. faecium infection and 11 with E. faecalis infection. The 28-day all-cause mortality rate was 21.6 %. In univariate analysis, vancomycin trough level (≤ 15 µg/mL; p = 0.042), age (p = 0.044), and septic shock (p = 0.049) were associated with 28-day mortality but not AUC24/MIC (> 389; p = 0.479). In multivariate analysis, vancomycin trough concentration (≤ 15 µg/mL; p = 0.041) and younger age (p = 0.031) were associated with 28-day mortality in patients with enterococcal bacteremia. CONCLUSIONS: In this study, a vancomycin trough level of 15 µg/mL or lower was associated with 28-day mortality in enterococcal bacteremia. However, relatively large prospective studies are needed to examine the efficacy of vancomycin PK/PD parameters in patients with enterococcal bacteremia.

Homeostasis model assessment of insulin resistance in a general adult population in Korea: additive association of sarcopenia and obesity with insulin resistance.

BACKGROUND: Insulin resistance (IR) is a major factor associated with type 2 diabetes. Using homeostasis model assessment of insulin resistance (HOMA-IR), we aimed to elucidate the factors associated with IR risk, especially the cumulative effect of obesity and sarcopenia on IR. METHODS: A total of 8,707 adults from the fourth and fifth Korean National Health and Examination Surveys were studied. Laboratory, anthropometric and lifestyle factors were analysed to reveal their association with HOMA-IR and IR risk. Subjects were divided into four groups according to the presence of obesity and sarcopenia to identify their effect on IR risk. RESULTS: We found that high triglycerides and alanine aminotransferase, low high-density lipoprotein cholesterol, obesity and sarcopenia were independent risk factors for IR in both sexes. Obese men with sarcopenia had a significantly higher risk of IR than men who were obese or sarcopenic (but not both). The additive effect of sarcopenia with obesity on IR risk was not observed in women. Cut-offs of HOMA-IR for determining IR were calculated as 75 percentile value of young healthy subpopulation, 2·19 in men and 2·18 in women. These cut-offs could distinguish individuals with impaired fasting glucose from normal ones, with a sensitivity of 65·4% (men) and 73·3% (women), and a specificity of 68·8% (men) and 69·4% (women). CONCLUSION: These data showed that obese men with sarcopenia exhibited a significantly higher IR risk than obese, nonsarcopenic men. In women, body composition did not affect IR if they were already obese.