Vancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality

Figures & data

Figure 1 The inclusion and exclusion criteria used during the screening process.

Table 1 Sample Characteristics (n=301)

Age (Years), (Mean, SD)			60	20
Female, (n, %)			102	33.9
Weight (kg), (mean, SD)			69	21.5
Obese (body mass index>30 kg/m^2), (n, %)			73	24.3
Diabetes mellitus, (n, %)			161	53.5
Hypertension, (n, %)			182	60.5
Liver disease, (n, %)			32	10.6
Chronic kidney disease, (n, %)			64	21.3
Heart failure, (n, %)			49	16.4
APACHE II Score (mean, SD)			15.9	7.1
Acute coronary syndrome, (n, %)			63	20.9
Admission GCS (mean, SD)			9.2	4.7
Intubated on mechanical ventilation, (n, %)			195	64.8
Shock (n, %)		Any shock	95	31.6
		Septic	48	15.9
		Cardiogenic	22	7.3
		Hypovolemic	20	6.6
		Distributive	3	1
		Obstructive	2	0.7
vasoactive-inotropic score (n, %)		≥1	115	38.2
		<1	186	61.8
Serum creatinine (μmol/L), (mean, SD)			134.7	127.3
eGFR (mL/min/1.73 m^2), (n, %)		<20	37	12.3
		20–50	64	21.3
		>50	199	66.3
Albumin (g/L), (mean, SD)			30.6	6.3
Platelets count (1000×10^6/L), (mean, SD)			265.9	157.7
Type of infection (n, %)		Severe*	100	33.2
		Less severe	201	66.8
Sources of gram-positive infection (n, %)		Bacteremia	182	60.5
		Respiratory infection	76	25.2
		Skin infection	18	5.9
		Others	25	8.4
Organism, (n, %)	Staphylococcus aureus	MRSA	70	23.3
		MSSA	113	37.5
	Staphylococcus non aureus		66	22.0
	Streptococcus Spp		19	6.3
	Enterococcus Spp		24	8
	Others		9	3
Loading dose, (n, %)			50	16
Initial vancomycin levels within therapeutic range, (n, %)			168	55.8

Notes: *Sepsis, pneumonia, meningitis, osteomyelitis, and endocarditis.

Figure 2 Patient who reached the target trough in initial vancomycin trough by age groups.

Table 2 Bivariate Analyses of Factors Associated with the Initial Vancomycin Trough Levels (Within Range)

Factors	B	SE	Chi-Square	P-value	95% CI for OR
					OR	LCL	UCL
Female	1.083	0.263	16.888	0.001*	2.95	1.762	4.947
Age (years)	0.038	0.007	33.875	0.001*	1.04	1.025	1.052
Weight (kg)	0.008	0.006	2.121	0.145	1.01	0.997	1.019
Microorganism- MRSA**	−0.081	0.274	0.086	0.769	0.92	0.539	1.579
Previous MDR	0.492	0.311	2.507	0.113	1.64	0.889	3.011
Loading dose	0.728	0.334	4.76	0.029*	2.07	1.077	3.98
Septic shock	0.273	0.319	0.73	0.393	1.31	0.703	2.457
Diabetes mellitus	0.886	0.238	13.868	0.001*	2.43	1.521	3.864
Hypertension	1.355	0.249	29.625	0.001*	3.88	2.38	6.313
liver disease	−0.402	0.375	1.149	0.284	0.67	0.321	1.395
Cancer	−0.577	0.354	2.653	0.103	0.56	0.28	1.125
Intubated on mechanical ventilation	−0.109	0.244	0.199	0.655	0.9	0.556	1.446
Heart failure	0.691	0.335	4.265	0.039*	2	1.036	3.846
Acute coronary syndrome	0.849	0.308	7.62	0.006*	2.34	1.279	4.271
Asthma	0.107	0.597	0.032	0.858	1.11	0.345	3.589
Chronic kidney disease	0.434	0.291	2.224	0.0136	1.54	0.872	2.733
Bacteremia	0.588	0.239	6.067	0.014	1.8	1.128	2.873
Respiratory infection (Source)	−0.67	0.268	6.231	0.013*	0.51	0.302	0.866
eGFR (mL/min/1.73 m^2)	−0.012	0.003	23.654	0.001*	0.99	0.983	0.993
Serum creatinine (mmol/l)	0.004	0.001	9.083	0.003*	1	1.001	1.006
Platelets (1000×10^6/L)	0.002	0.001	6.299	0.012*	1	1	1.004
GCS	0.044	0.025	3.035	0.081	1.05	0.994	1.099
VIS	−0.268	0.122	4.844	0.028*	0.77	0.602	0.971
APACHE II Score	0.029	0.017	2.934	0.087	1.03	0.996	1.063
Albumin (g/L)	−0.059	0.02	8.742	0.003*	0.94	0.906	0.98

Notes: *Significant at α=0.05; ** As compared with non-MRSA microorganism.

Table 3 Multivariate Analysis of Factors Associated with Achieve Initial Vancomycin Trough Levels (Within Range)

	B	SE	Chi-Square	P-value	95% CI for aOR
					aOR	LCL	UCL
Intercept	0.763	1.048	0.531	0.466
Female	0.473	0.161	8.66	0.003*	2.575	1.371	4.834
Age	0.023	0.008	8.15	0.004*	1.024	1.007	1.040
Loading dose	0.447	0.201	4.942	0.026*	2.445	1.112	5.377
Bacteremia	0.362	0.151	5.719	0.017*	2.061	1.139	3.729
eGFR (mL/min/1.73 m^2)	−0.007	0.003	4.440	0.035*	0.993	0.987	1
Platelets (1000×10^6/L)	0.003	0.001	8.733	0.003*	1.003	1.001	1.005
Albumin (g/L)	−0.058	0.023	6.248	0.012*	0.944	0.902	0.988

Notes: *Significant at α=0.05.

Table 4 Bivariate Analyses of Factors Associated with the Risk of 30-Day Mortality in Patients Who Received Vancomycin

	B	SE	Chi-Square	P-value	95% CI for HR
					HR	LCL	UCL
Female	0.890	0.266	11.206	0.001*	2.436	1.446	4.103
Age (years)	0.022	0.007	9.072	0.003*	1.023	1.008	1.038
Weight (kg)	0.016	0.005	12.21	0.001*	1.016	1.007	1.026
Microorganism - MRSA	−0.023	0.316	0.005	0.942	0.977	0.526	1.815
Previous MDR	−0.365	0.381	0.917	0.338	0.694	0.329	1.465
Loading dose	−0.206	0.381	0.291	0.590	0.814	0.386	1.719
Cardiogenic shock	1.139	0.364	9.777	0.002*	3.123	1.530	6.378
Diabetes mellitus	0.192	0.268	0.513	0.474	1.212	0.716	2.050
Hypertension	0.623	0.301	4.283	0.039*	1.864	1.034	3.361
Asthma	0.597	0.519	1.325	0.250	1.816	0.657	5.019
Liver disease	0.774	0.336	5.311	0.021*	2.168	1.123	4.188
Cancer	1.013	0.308	10.811	0.001*	2.753	1.505	5.036
Intubated on mechanical ventilation	0.756	0.325	5.408	0.020*	2.129	1.126	4.025
Heart failure	0.648	0.301	4.632	0.031*	1.911	1.060	3.446
Acute coronary syndrome	0.502	0.290	3.012	0.083	1.653	0.937	2.915
Chronic kidney disease	0.564	0.285	3.923	0.048*	1.758	1.006	3.074
Bacteremia	−0.123	0.268	0.211	0.646	0.884	0.523	1.496
Respiratory infection (Source)	0.064	0.301	0.046	0.831	1.066	0.591	1.923
eGFR (mL/min/1.73 m^2)	−0.009	0.003	9.764	0.002*	0.991	0.985	0.996
Serum creatinine (mmol/l)	0.001	0.001	0.973	0.324	1.001	0.999	1.003
Platelets (1000×10^6/L)	−0.001	0.001	0.533	0.465	0.999	0.998	1.001
GCS	−0.018	0.030	0.372	0.542	0.982	0.926	1.000
APACHE II Score	0.070	0.017	16.328	0.001*	1.072	1.037	1.110
VIS	−0.355	0.178	3.973	0.046*	0.701	0.494	0.994
Albumin (g/L)	−0.013	0.022	0.356	0.551	0.987	0.946	1.030
Fail to reach trough level**	0.660	0.290	5.197	0.023*	1.935	1.097	3.413

Notes: *Significant at α=0.05. **Fail to reach therapeutic range (Initial trough).

Table 5 Multivariate Analysis of Factors Associated with the Risk of 30-Day Mortality in Patients Who Received Vancomycin

	B	SE	Chi-Square	P-value	95% CI for aHR
					aHR	LCL	UCL
Female	0.967	0.305	10.039	0.002*	2.63	1.446	4.782
Weight (kg)	0.020	0.005	14.812	0.001*	1.021	1.010	1.031
Cancer	1.488	0.344	18.769	0.001*	4.429	2.259	8.684
APACHE II Score	0.066	0.020	10.857	0.001*	1.068	1.027	1.110

Notes: *Significant at α=0.05.

Figure 3 30-day survival curves by cancer.