2015/1/21在醫院感控小組報書報討論。 A journal reading presented to ID group meeting on 2015/1/21.

1. A Retrospective, post hoc, Subgroup Analysis of the
Phase 3 ATTAIN Studies
BMC Infectious Diseases 2014, 14:183
簡百秀
2015.1.21

2.  Existing data are not consistently supportive of
improved clinical outcome when vancomycin
dosing regimens aimed at achieving target trough
levels are used.
 Two phase III ATTAIN studies: the efficacy and
safety of telavancin vs. vancomycin for treatment
of G(+) nosocomial pneumonia in adults patients

3.  Gave vancomycin 1 g Q12H and adjusted for
weight and/or renal function.
 274 studies sites across 38 countries, total 98
patients with Staphylococcus aureus nosocomial
pneumonia and available vancomycin trough
levels
 Then grouped by vancomycin trough level: < 10
mcg/mL, 10~15 mcg/mL, ≧ 15 mcg/mL.

5.  No significant differences in clinical cure
 High vancomycin trough  more renal adverse
events

7. 1. ARF may have influenced vancomycin
distribution and associated with poor clinical
outcome
 Excluding pt with previous preexisting ARF  the
same trend
2. Concomitant nephrotoxic medication
3. Limitations:
1) ATTAIN studies were not designed to evaluate the
impact of vancomycin trough levels.
2) Patients were not randomized to achieve a
specific trough target.
3) Sample size is too small to draw a definitive
conclusion.

8. 95 received
vancomycin
11 nephrotoxicity
1 without other
nephrotoxic
drugs
10 with other
nephrotoxic
drugs
84 no
nephrotoxicity
17 with other
nephrotoxic
drugs
67 without other
nephrotoxic
drugs
11 of 63 high
vancomycin
trough group
Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A: High-dose vancomycin
therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and
toxicity. Arch Intern Med 2006, 166(19):2138–2144.

9. 1. Higher vancomycin trough levels
Not result in improved clinical response
Increase the incidence of nephrotoxicity.
2. Prospective controlled studies are required to
further assess the validity of the current
vancomycin dosing recommendations.

10.  Barriere et al. BMC Infectious Diseases 2014,
14:183
 Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-
Beringer A: High-dose vancomycin therapy for
methicillin-resistant Staphylococcus aureus
infections: efficacy and toxicity. Arch Intern Med
2006, 166(19):2138–2144.
 Association Between Vancomycin Minimum
Inhibitory Concentration MIC & Mortality among
Patients with Staphylococcus aureus BSIs: a
Systematic Review & Meta-analysis. JAMA.
2014;312(15):1552-1564.