The glycopeptide vancomycin is commonly used to treat a variety of bacterial infections, especially multi-drug resistant species of bacteria such as Staphylococcus aureus. While vancomycin remains an effective treatment for Staphylococcal infections, strains of vancomycin-intermediate Staphylococcus aureus (VISA) and vancomycin-resistant Staphylococcus aureus (VRSA) strains have emerged. One mechanism for the increased antibiotic (vancomycin-intermediate) resistance is due to acquisition of various mutations within different genes that alter the cell wall physiology making vancomycin ineffective. Biofilm development is a bacterial mode of growth that can lead to mutations within the bacterial genome and allow for advantageous traits such as increased antibiotic resistance. The biofilm environment can be harsh, having niches that are often nutrient and oxygen deficient, leading to damaged DNA. This DNA damage induces the SOS response to repair double-stranded breaks in DNA, and enables bacterial survival. However, DNA repair via the SOS response is an error-prone system that often results in mutations within the genome. We hypothesize that the acquisition of vancomycin intermediate resistance is an unintended consequence within the S. aureus biofilm environment. To assess the hypothesis, both wildtype and RecA/LexA deficient biofilms were grown in microtiter assays with and without the addition of sub-inhibitory concentrations of vancomycin. Efficiency of plating techniques were used to quantify the subpopulation of biofilm-derived S. aureus cells that developed vancomycin intermediate resistance. Microtiter assays and efficiency of plating techniques were repeated using multiple strains of S. aureus. Experimentation was repeated by comparing the subpopulation of biofilm-derived and planktonic culture cells that grew in intermediate-concentrations of vancomycin with three additional strains of S. aureus. Mutagenesis that occurs within the biofilm environment was further assessed by plating both biofilm-derived and planktonic culture cells on sheep blood agar and tryptic soy agar supplemented with streptomycin, novobiocin, or rifampicin, and quantifying the non-hemolytic variants that grew on blood agar, or the number of colonies that grew in the presence of an antibiotic, respectively. The biofilm results were then compared to the results from wildtype and RecA/LexA deficient planktonic cultures and used to determine the impact of the S. aureus biofilm environment in the acquisition of vancomycin intermediate resistance. The results indicate that a larger subpopulation of cells derived from wildtype biofilms grew in increased concentrations of vancomycin (4 µg/ml) as compared to the planktonic counterpart. The subpopulation of cells derived from wildtype biofilms was also higher than all subpopulations of RecA/LexA deficient biofilm and planktonic cultures. Further experimentation indicates that this phenomenon may not be specific to all strain backgrounds of S. aureus. Additionally, growth with sub-inhibitory concentrations of vancomycin did not exhibit an exaggerated subpopulation of cells in biofilm environments or planktonic cultures that could grow in intermediate-concentrations of vancomycin, however standard antibiotic testing suggests that the mechanism by which point mutations occur in planktonic conditions may be mediated by the RecA and SOS response system. Bacteria that live in a biofilm community are often subjected to harsh environments. In order to survive, the SOS response system will be activated to repair damaged DNA. This error prone process will result in mutational changes and increased genetic diversity. The VISA phenotype may be a result of the diversity that occurs within the biofilm environment. While the VISA phenotype would be an unintended consequence of genetic diversity and gene transfer in the biofilm setting, it demonstrates that mutations that occur within the biofilm environment allow for S. aureus to better adapt to new environments, including the presence of widely used antibiotics such as vancomycin.

Background: Staphylococcus aureus is an aerobic, Gram positive commensal organism that is capable of causing a wide spectrum of disease. This study contributes to previously published literature regarding daptomycin versus vancomycin use in S. aureus bacteremia (SAB). Methods: Adult patients admitted between 2010 and 2014, billed for ICD-9 code V09.0, 038.11, 038.12, 041.11, or 041.12, and received vancomycin and daptomycin were included in this retrospective analysis. Patients were stratified by time to change in antibiotics from vancomycin to daptomycin to the early switch (1-3 days), intermediate switch (4-7 days), or late switch (8 days or later) group. The primary outcome was treatment failure defined as 30-day recurrence, 60-day all-cause mortality, and 90-day all-cause readmission. Results: 193 patients were enrolled in the final cohort. The overall treatment failure rate was 18% with no differences between early switch, intermediate switch, and late switch (P=0.72) groups. Independent predictors of treatment success were length of stay (OR=1.035) and time to positive culture (OR=0.961). Conclusions: Results of this study did not demonstrate a difference in treatment failure based on time to switch from vancomycin to daptomycin. Future research should focus on optimizing use of vancomycin and daptomycin and medical management of SAB.

Context: Daptomycin is the only antibiotic available with in vitro bactericidal activity against vancomycin-resistant enterococci (VRE). Its increased use has resulted in cases of decreased daptomycin efficacy. Recent in vitro studies have shown effective use of beta (beta)-lactam and daptomycin antibiotics, as a combination therapy, in the treatment of VRE. We describe a case of effective treatment in a patient with VRE infection using dual ampicillin and daptomycin therapy that shows bench-to-bedside application of the abovementioned finding. Case Report: A 76-year-old gentleman with a history of bilateral arthroplasty was admitted with a swollen left knee. Blood cultures were positive for Enterococcus faecium. Left knee joint aspiration showed leukocytosis and alpha defensins. Extensive imaging did not show any other source of infection. Culture sensitivity results showed multidrug-resistant enterococci sensitive to daptomycin. The patient was started on intravenous (IV) daptomycin. His left knee prosthesis was explanted and a spacer was placed. The patient continued to be bacteremic for 10 days after removing the knee prosthesis. The patient was trialed on combination IV ampicillin and daptomycin. His blood culture turned negative 2 days later. The patient was discharged home to continue 6 weeks of IV ampicillin and daptomycin. Conclusion: The exact mechanism of the daptomycin/ampicillin synergy effect is unclear. Current hypothesis suggests that ampicillin causes a reduction in the net positive charge of the bacterial surface, possibly by releasing lipoteichoic acid (LTA) from the cell wall. This process increases the ability of the cationic daptomycin/calcium complex to bind to the cell wall more effectively. Our case shows the clinical application of the same. A prospective randomized control trial to explore the effectiveness of dual antibiotic therapy in vivo is needed. If proven, daptomycin/-lactam can become a standard of care to treat VRE and decrease daptomycin nonsusceptibility.

In the past decade, Staphylococcus aureus has developed two distinct vancomycin resistance mechanisms. First, the bacterium is capable of generating a thickened, poorly crosslinked cell wall that creates false targets. These targets cause vancomycin to bind at the periphery of the thickened peptidoglycan, allowing normal cell wall formation to continue at the cell membrane. Second, S. aureus has acquired genes from Enterococcus that encode an alternative stem peptide. The genes, known as van genes, alter the target of vancomycin, rendering vancomycin treatment ineffectual.In this work, we attempted to further characterize both mechanisms of vancomycin resistance. First, a potential link between up-regulated purine biosynthesis and increased vancomycin resistance due to a thickened cell wall was examined. Despite exploration of multiple mechanisms to increase purine levels within the cell, increased purine synthesis did not provide S. aureus with any advantage in the presence of vancomycin. However, during the investigation, purine biosynthesis in S. aureus was further characterized by confirming purr as the repressor of the purine pathway and demonstrating its sensitivity to mutation.Next, the relationship between homotypic oxacillin resistance and increased vancomycin resistance in the absence of the van genes was investigated. Vancomycin passage of two heterotypic methicillin resistant S. aureus (MRSA) caused these strains to convert to homotypic oxacillin resistance in the absence of oxacillin exposure. Additionally, conversion of heterotypic oxacillin resistant strains to homotypy by oxacillin passage increased strain survival in vancomycin. The SOS response was examined as the possible link between conversion to homotypic oxacillin resistance and increasing vancomycin resistance due to a thickened cell wall. The current study, however, detected no induction of the SOS response during vancomycin exposure.Lastly, the relationship between oxacillin resistance and vancomycin resistance due to the acquisition of the van genes was examined. In vitro and in vivo methods were utilized to determine the effectiveness of a combination of β-lactam antibiotics and vancomycin to treat vancomycin resistant S. aureus (VRSA) infections. Combination therapy provided a significant advantage over untreated control or either antibiotic alone in the rabbit model of endocarditis.

Enterokokken gelten primär als opportunistische Erreger mit geringer Pathopotenz. Sie zeichnen sich allerdings durch ausgeprägte natürliche und erworbene Resistenzen gegen eine Vielzahl von Antibiotika aus. Besorgniserregend ist hierbei insbesondere das Auftreten von Vancomycin-resistenten Enterokokken. Glycopeptidantibiotika, wie Vancomycin und Teicoplanin, werden als Reserveantibiotika gegen multiresistente gram-positive Erreger, wie zum Beispiel Methicillin-resistente Staphylococcus aureus-Stämme (MRSA) eingesetzt. Der VanA-Typ der Glycopeptidresistenz, welcher zuerst in Enterococcus faecium beschrieben wurde, ist die in Zentraleuropa vorherrschende Variante der Glycopeptidresistenz. Das Transposon Tn1546, das die vanA-Resistenzdeterminante kodiert, liegt häufig auf großen konjugativen Plasmiden vor und kann zwischen Enterokokken-Stämmen transferiert werden. In dieser Arbeit wurde der direkte Einfluss von Vancomycin und eines weiteren Antibiotikums, Flavophospholipol (FPL), auf die Rate des konjugativen Transfers des vanA-Operons in E. faecium untersucht. Das Phosphoglycolipidantibiotikum FPL wird derzeit als Leistungsförderer in der Tiermast eingesetzt. Beide Antibiotika induzieren die Expression der Glycopeptidresistenz vom VanA-Typ. Es konnte gezeigt werden, dass Flavophospholipol in unterschiedlichen Konzentrationen die Häufigkeit des Transfers von konjugativen VanA-Plasmiden sowohl in klinischen E. faecium-Isolaten, als auch in E. faecium-Stämmen aus Tierfaeces signifikant hemmte. Vancomycin zeigte keinen signifikanten Effekt auf die Transferrate der VanA-Plasmide. Somit konnte nachgewiesen werden, dass in E. faecium kein funktionaler Zusammenhang zwischen der Induktion des vanA-Operons durch Vancomycin und FPL und der Transferfrequenz der konjugativen VanA-Plasmide unter dem Einfluss der beiden Antibiotika besteht. Weiterhin wurde die Induktion des vanA-Operons unter dem Einfluss verschiedener Antibiotika in einem E. faecium-Isolat näher untersucht. Hierbei wurde die Expression des 39 kDa VanA-Ligase Proteins direkt durch das Western Blot-Verfahren dargestellt. Eine Induktion der Expression des VanA-Ligase Proteins erfolgte durch Inhibitoren der späten Phase der Zellwandsynthese, wie Vancomycin, Flavophospholipol, Bacitracin und Tunicamycin. Außerdem konnte eine leichte Induktion des VanA-Ligase Proteins durch Fosfomycin, Cefalexin und Cefuroxim, Meropenem und Clindamycin nachgewiesen werden. Somit konnte gezeigt werden, dass Cefuroxim und Clindamycin zwei Antibiotika, die in klinischen Studien eine Besiedelung mit VRE begünstigen, auch eine geringe Zunahme der VanA-Ligase Expression bewirken. Zudem wurde deutlich, dass durch den Einfluss von Hitzestress und osmotischem Stress keine Induktion der 39 kDa VanA-Ligase Bande erfolgt. Ein weiteres Ziel dieser Arbeit war die Identifizierung einer putativen Resistenz-determinante gegen Flavophospholipol. Die Eigenschaft der FPL-Resistenz konnte nicht durch in vitro-Filterkonjugation von FPL-resistenten auf FPL-sensitive E. faecium-Stämme übertragen werden. Zur molekularen Untersuchung der Resistenz gegen Flavophospholipol wurde ein resistenter E. faecium-Stamm durch das konjugative Transposon Tn916 mutagenisiert. In allen identifizierten FPL-sensitiven Mutanten war die Insertionstelle des Transposons und dessen Orientierung im Chromosom identisch und es deletierte ein 1,5 kb großer genomischer Bereich „downstream“ der Transposon-Insertionsstelle. Dieser Bereich umfasste das 3´-Endes des Gens für eine putative Threonyl-tRNA Synthetase und den Genlocus für einen putativen Transkriptionsregulator. Die Sequenzen in allen Mutanten begannen ca. 200 bp vor dem Startcodon eines Gens für ein putatives Penicillin-Bindeprotein (PBP). In Northern Blot-Analysen konnte gezeigt werden, dass die Transkription des putativen PBP in der Mutante 64/3-1 schwächer war als im Wildtyp 64/3. Außerdem wurden durch 3H Penicillin-Markierung von PBP-Extrakten Unterschiede im Expressionsmuster der Penicillin-Bindeproteine im Wildtyp und in der Mutante deutlich. Während im Wildtyp fünf Penicillin-Bindeproteine zu erkennen waren, fehlten PBP2 und PBP3 in der Mutante 64/3-1. Die Größe von PBP3 entsprach hierbei der geschätzten Größe des putativen PBP von 79 kDa. In der Mutante 64/3-1 fand wahrscheinlich durch den Verlust eines putativen Regulators oder wichtiger regulatorischer Bereiche eine Veränderung im Expressionsmuster der Penicillin-Bindeproteine statt, welche zum FPL-sensitiven Phänotyp führte. In dieser Arbeit konnte zudem gezeigt werden, dass Flavophospholipol in E. faecium an PBP2 und PBP3 bindet und es sich hierbei um bifunktionale „high molecular weight“ Penicillin-Bindeproteine mit Transglycosylase- und Transpeptidase-Untereinheit handeln muss. / Enterococci are primary opportunistic pathogens. Species of this genus are inherently resistant to many antimicrobial agents and readily acquire additional resistances, which is likely the reason why enterococci have become prominent nosocomial pathogens. Glycopeptides, such as vancomycin and teicoplanin are the antibiotics of last resort for the treatment of methicillin-resistant staphylococci (MRSA). In Central Europe, the VanA-type is the most frequent genotype of acquired glycopeptide resistance. The vanA gene cluster is located on transposons of the Tn1546 type, which are integrated into conjugative plasmids, and can therefore be transferred among enterococcal strains. In this study, the influence of vancomycin and flavophospholipol (FPL) on the conjugative transfer of vanA plasmids was determined in several Enterococcus faecium strains. FPL is a phosphoglycolipid antibiotic used as a growth promoter in animal husbandry. Both antibiotics have an inducing effect on the vanA operon. We showed that subinibitory concentrations of FPL inhibit the tranfer of vanA plasmids. This inhibitory effect is dose-dependend and was observed both in clinical and animal isolates of E. faecium. Vancomycin had no significant effect on the transfer rate of vanA plasmids. These results suggest that there is no functional link between the induction of vancomycin resistance of VanA-type and the frequency of transfer of conjugative vanA plasmids in E. faecium. Furthermore, the influence of some antibiotics on the VanA ligase protein expression was examined by Western-blotting analysis. Induction of the 39 kDa protein could be detected after addition of some cell-wall active agents such as vancomycin, flavophospholipol, bacitracin and tunicamycin. Fosfomycin, cefalexine and cefuroxime as well as meropenem and clindamycin had a weaker inducing effect on the VanA ligase protein expression. Heat- and osmotic stress had no effect on the expression of the VanA ligase. A further objective of this study was the identification of a putative Flavophospholipol resistance determinant. Transfer of the FPL resistance between E. faecium strains could not be detected in filter mating experiments. For the molecular analysis of the Flavophospholipol resistance an insertional mutagenesis was carried out in a FPLr E. faecium strain using the conjugative transposon Tn916. The chromosomal insertion sites of the transposon were identical in all identified mutants with a 1.5 kb sequence deletion downstream of Tn916. Sequence analysis of the deleted area revealed homolgy to the 3´-end of a putative threonyl-tRNA synthetase gene and the gene of a putative regulator. The sequences in all mutants began about 200 bp upstream of the startcodon of a putative penicillin-binding protein (PBP) gene. The transcription of this penicillin-binding protein was weaker in the transposonmutant 64/3-1 than in the wildtype 64/3 as could be shown by Northern hybridisation. Further, binding-studies using 3H penicillin showed differences in the expression pattern of the penicillin-binding proteins between wildtype and mutant 64/3-1. The wildtype contained five PBP, while PBP2 and PBP3 where not marked in mutant 64/3-1. The size of PBP3 corresponds with an estimated size of the putative penicillin-binding protein of 79 kDa. This results suggest that the change in the penicillin-binding protein expression pattern of FPLs mutant 64/3-1 may be caused by the loss of a putative regulator or an important regulatory sequence. The PBP studies also show that FPL binds to PBP2 and PBP3 in E. faecium and these are likely bifunctional high molecular weight penicillin-binding proteins with transglycosylase- and transpeptidase-modules.

Os eventos adversos, devido à grande ocorrência, são considerados um importante problema de saúde pública além de elevarem os custos com a saúde. Dessa forma, existe a necessidade de um sistema eficiente de farmacovigilância para prevení-los sendo a monitorização intensiva uma excelente estratégia para se alcançar este objetivo, pois permite a identificação e o conhecimento dos eventos adversos, além de medir sua incidência e melhorar as notificações voluntárias. Por esta razão, o presente estudo propôs a avaliação deste método em eventos adversos relacionados ao antimicrobiano vancomicina. As informações coletadas, provenientes dos bancos de dados e dos prontuários do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP), são referentes aos pacientes internados no hospital em tratamento com vancomicina no período de 01/09/2008 a 31/08/2009. Identificou-se 1719 tratamentos de 1302 usuários. Destes tratamentos, 521 foram excluídos por serem profiláticos. A idade média dos 1198 pacientes monitorados foi de 39,33 (± 27,66) anos e 58,68% pertenciam ao gênero masculino. Os diagnósticos infecciosos prevalentes para o tratamento com vancomicina foram pneumonia (18,95%), sepse (11,19%) e infecção relacionada a cateter (10,27%) com período médio de duração do tratamento de 11,47 (±7,79) dias geralmente na dose de 2000 mg ao dia (35,98%). Foram identificados indicadores de eventos adversos em 85,81% dos tratamentos, sendo a incidência de eventos adversos de 7,18%. A incidência de reações adversas (RAM) foi de 5,93% e de erros de medicação 2,57%. A causalidade das RAM foi prevalentemente provável (49,29%) e a gravidade moderada (54,93%). As RAM foram essencialmente do tipo B (81,69%) e os erros de medicação relativos à prescrição (87,10%). A comparação entre os grupos controle e estudo não apresentou diferenças significativas, demonstrando a necessidade de monitorização de todos os parâmetros relacionados a eventos adversos com a vancomicina. Dessa forma, fica evidente a importância da monitorização intensiva e da presença dos farmacêuticos clínicos na equipe de saúde para melhorar a eficiência da farmacovigilância, como demonstrado por este estudo. Diante dos resultados, conclui-se que o método de monitorização intensiva utilizando base de dados e prontuários, além da participação de um farmacêutico clínico, promove o conhecimento, a avaliação e a compreensão dos eventos adversos presentes em uma instituição, permitindo a esquematização de estratégias para a sua prevenção. / Adverse events, due to the high occurrence, are considered an important public health problem in addition to driving up health care costs. There is therefore a need for an efficient system of pharmacovigilance to prevent them being the intensive monitoring an excellent strategy for achieving this goal because it allows the identification and knowledge of the adverse events, in addition to measuring its incidence and improve spontaneous reports. For this reason, the present study evaluated this method in adverse events related to antibiotic vancomycin. The informations collected from databases and records of the Hospital of the Medical School of Ribeirão Preto-SP (USP-HCFMRP), refers to hospital patients treated with vancomycin for the period 01/09/2008 to 31/08/2009. We evaluated 1719 treatments in 1302 users, of which 521 were excluded because they were prophylactic. The average age of 1198 patients was 39.33 years (±27.66) and 58.68% were males. Prevalent infectious diagnoses for treatment with vancomycin were pneumonia (18.95%), sepsis (11.19%) and catheter-related infection (10.27%) with mean duration of treatment of 11.47 days (± 7.79) usually at a dose of 2000 mg daily (35.98%). We identified indicators of adverse events in 85.81% of treatments, and the incidence of adverse events was 7.18%. The adverse drug reactions (ADR) incidence was 5.93% and 2.57% of medication errors. The causality of ADR was probable (49.29%) and severity was moderate (54.93%). The ADR were mainly of type B (81.69%) and medication errors related to prescription (87.10%). Comparisons between the study and control groups showed no significant differences, demonstrating the need for monitoring of all parameters related to adverse events with vancomycin. Thus, it is clear the importance of the intensive monitoring and the presence of clinical pharmacists in the health team to improve the efficiency of pharmacovigilance, as demonstrated by this study. Before the results, we conclude that the method of intensive monitoring using the database and records, plus the involvement of a clinical pharmacist, promotes knowledge, assessment and understanding of adverse events presents in an institution, enabling the layout of strategies to prevention.

Investigaram-se 108 pacientes, entre 20 a 85 anos, com internação no pós-operatório em unidades de recuperação cardíaca. Pacientes submetidos a procedimentos cirúrgicos e portadores de quadros infecciosos diversos - broncopneumonia, endocardite, mediastinite e sepse - causados por agentes etiológicos sensíveis à terapia com vancomicina, foram selecionados para este estudo retrospectivo. A vancomicina é um antibiótico muito utilizado, principalmente na terapia de infecções hospitalares graves, predominantemente causadas por Staphylococcus aureus, microorganismo gram positivo resistente à meticilina e oxacilina. Na primeira fase do estudo realizou-se o desenvolvimento e validação da metodologia analítica para dosagem das concentrações plasmáticas da vancomicina pela técnica de cromatografia líquida de alta eficiência (CLAE). O método consiste em simples purificação das amostras biológicas em acetonitrila e detecção em ultravioleta (UV 230 nm). Empregou-se, para a quantificação do fármaco, coluna analítica Shimpack® CLC-ODS, 150 x 6 mm, 5 µm e fase móvel constituída por tampão fosfato 0,05 M, pH 4,5, metanol e acetonitrila, na proporção 80:15:5, pH da fase móvel entre 4,0-4,5, em sistema isocrático de diluição, fluxo 0,8 ml/minuto. Solução metanólica de b-etil-hidroxiteofilina foi utilizada como padrão interno no ensaio. Na fase seguinte da investigação, coletaram-se 2 amostras de sangue de cada paciente, em níveis de pico (Css MÁX), 2 horas após o início da infusão e vale (Css MÍN), imediatamente antes da infusão subsequente, na terapia de manutenção - \"steady state\". As concentrações plasmáticas da vancomicina foram determinadas e utilizadas para estimativa dos parâmetros farmacocinéticos, por meio de modelagem cinética monocompartimental. Determinou-se a meia-vida biológica de eliminação (t(1/2)b) pelo método gráfico e calcularam-se a depuração plasmática ou ?clearance? total (ClT) e o volume de distribuição (Vd) do fármaco no organismo. Estimou-se o índice de acúmulo da vancomicina, pela razão vale/pico (V/P). Efetuou-se, na última etapa do protocolo, o estudo comparativo da cinética da vancomicina, com a população dividida em grupos, classificados de acordo com a idade, função renal, tipo de infecção e dose total diária. Utilizou-se a estatística não paramétrica para análise de significância (teste de Kruskall Wallis). A função renal é o fator determinante da farmacocinética da vancomicina e das doses da antibioticoterapia, sendo responsável pelo acúmulo do fármaco em pacientes no pós-operatório cardíaco. Idade e tipo de infecção não demonstram influência significativa na disposição cinética da vancomicina nos indivíduos estudados. / In this study, 108 patients were investigated, aged 20 to 85 years old, admitted in the intensive care units during the post-operative period. Patients submitted to surgical procedures and with several infectious - bronchopneumonia, endocarditis, mediastinitis, and sepsis - caused by agents sensitive to vancomycin therapy, were selected for this retrospective study. The vancomycin is a widely prescribed antibiotic, mainly for therapy of serious hospital infections caused by Staphylococcus aureus, gram positive microorganism resistant to meticilin and oxacilin. Firstly, the analytic methodology was developed and validated for dosage of the vancomycin plasmatic concentrations by the technique of high efficiency liquid chromatography (HPLC). The method consists of biological samples simple purification in acetonitrile and detection in ultraviolet (UV 230 nm). It was used for quantification of the drug analytical column Shimpack® CLC-ODS, 150 x 6 mm, 5 mm and mobile phase constituted by phosphate buffer 0,05 M, pH 4,5, methanol and acetonitrile, proportion 80:15:5, mobile phase pH 4,0-4,5, in isocratic dilution system, flow 0,8 ml/min. Solution of b-ethil-hydroxitheophylline in methanol was used as internal standard. In the following investigation phase, 2 blood samples from each patient were collected, at peak levels (Css MÁX - 2 hours after the infusion beginning), and at trough (Css MÍN - immediately before the subsequent infusion) in the maintenance therapy - steady state. Plasmatic vancomycin concentrations were used to estimate pharmacokinetics parameters, by monocompartimental kinetic model. Biological half-life of elimination (t(1/2)b) was determined by graphic method. The plasmatic purification or total clearance (ClT) and drug distribution volume (Vd) in the organism were calculated. It was estimated the vancomycin accumulation index, the reason trough/peak (V/P). Comparative study of vancomycin kinetics was performed with groups of patients, classified according to their age, renal function, infection type and daily total dose. Non parametric statistic were used for significancy analysis (Kruskall Wallis test). Renal function is a decisive factor of the vancomycin kinetics disposition and therapy doses, being responsible for drug accumulation in cardiac post-operative patients. Age and infection type did not demonstrate significant influence in the vancomycin pharmacokinetics in this study.

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No description available.

Purpose: Three different generic vancomycin products were compared using liquid chromatography–mass spectrometry (LC-MS) and open-access metabolomic tools. Methods: Single-lot samples of vancomycin hydrochloride from three different manufacturers (Hospira, APP Pharmaceuticals, and Pfizer) were reconstituted and injected into a high-resolution LC-MS system. The mass spectral fingerprints were compared for similarity of nonvancomycin B components using the XCMS Online system through Scripps University. Significance was defined as a p of ≤0.01 and a fold change of ≥1.5. The concentration of vancomycin B in each product was also measured using LC-MS on days 0, 1, 2, 4, 7, 10, and 14. Results: Qualitative comparisons of the products using the XCMS Online interface indicated the presence of significant differences among the products at the time of reconstitution; however, these variations seemed to converge after 14 days of storage. The concentration profiles of vancomycin B during refrigerated storage did not differ significantly among the three products. XCMS Online analyses revealed that the Pfizer and Hospira products were the most similar to each other. Conclusion:While there were no significant differences found in the concentration of vancomycin B among Pfizer, APP, and Hospira products, there were differences in their initial mass spectral analysis after reconstitution. Liquid chromatography–tandem mass spectrometry profiles of the ions or isotopes present in the three products showed significant differences in impurities such as crystalline degradation product (CDP)-1 and CDP intermediate. After 14 days of refrigerated storage, the differences among the products converged, and fewer distinct features could be detected.