Age-Related Differences in Vancomycin-Associated Nephrotoxicity and Efficacy in Methicillin-Resistant <i>Staphylococcus aureus</i> Infection: A Comparative Study between Elderly and Adult Patients
Lin Xi,
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
Affiliations
Lin Xi
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
Shanshan Li
Huashan Worldwide Medical Center, Huashan Hospital, Fudan University, Shanghai 200040, China
Mengting Chen
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
Xiaolan Huang
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
Nanyang Li
Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
Nanye Chen
Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
Hailan Wu
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
Qiyu Bian
Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
Xingchen Bian
Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
Xin Li
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
Minjie Yang
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
Xiaoyu Liang
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
Jufang Wu
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
Beining Guo
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
Yaxin Fan
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
Jing Zhang
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
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.
