Journal of Infection and Chemotherapy最新文献

{"title":"Primary pyogenic ventriculitis due to Streptococcus dysgalactiae treated with intralumbar vancomycin administration: A case report","authors":"Yayoi Miyamatsu,&nbsp;Ryutaro Tanizaki","doi":"10.1016/j.jiac.2025.102854","DOIUrl":"10.1016/j.jiac.2025.102854","url":null,"abstract":"<div><div>Intrathecal antibiotics are occasionally employed in the management of central nervous system infections; however, standard treatment regimens have not been clearly established, particularly for primary pyogenic ventriculitis in patients without an intraventricular drain. We report the first documented case of successful intralumbar administration of vancomycin, in combination with systemic antibiotics, for the treatment of primary pyogenic ventriculitis caused by <em>Streptococcus dysgalactiae</em> in a 65-year-old Japaneses woman. Despite receiving appropriate systemic antibiotic therapy, her level of consciousness showed no significant improvement, indicating that systemic therapy alone was insufficient to control the infection. Due to her advanced breast cancer, poor general condition, and limited prognosis, the neurosurgical team deemed intraventricular drainage inappropriate. As an alternative, intralumbar vancomycin therapy was initiated. Serial intrathecal vancomycin concentrations were measured during intralumbar vancomycin therapy, providing valuable pharmacokinetic data. This case highlights that intralumbar vancomycin may represent a feasible therapeutic alternative when systemic antibiotic therapy alone is insufficient. Further studies are warranted to elucidate the pharmacokinetics, efficacy, and safety of this therapeutic approach.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102854"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When malaria hides: a case report of sudden coma without prior fever in cerebral malaria","authors":"Fiona Valerie Muskananfola,&nbsp;Asep Purnama","doi":"10.1016/j.jiac.2025.102866","DOIUrl":"10.1016/j.jiac.2025.102866","url":null,"abstract":"<div><div>Malaria is a major global health burden. Severe malaria, including cerebral malaria (CM), significantly increases mortality and requires immediate treatment. CM often manifests as loss of consciousness and behavioural changes. In this case, a 19-year-old woman presented with sudden unconsciousness and rigor. Fever before admission was denied, but later developed during hospitalization. Given the patient's residence in a malaria-endemic area, a rapid diagnostic test (RDT) was performed and was positive. Microscopic examination was delayed but later confirmed <em>Plasmodium falciparum</em> infection. The patient was treated with intravenous artesunate, followed by primaquine and dihydroartemisinin-piperaquine (DHP). The patient improved following treatment; follow-up microscopy confirmed parasite clearance.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102866"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with TDF-to-TAF switching in chronic hepatitis B: A nationwide cohort study in South Korea","authors":"Hyemin Ha ,&nbsp;Kwang Il Seo ,&nbsp;Nam Kyung Je","doi":"10.1016/j.jiac.2025.102860","DOIUrl":"10.1016/j.jiac.2025.102860","url":null,"abstract":"<div><h3>Background</h3><div>Chronic hepatitis B, a primary cause of liver disease and cancer, requires long-term antiviral therapy. Tenofovir alafenamide (TAF), a novel targeted prodrug of tenofovir disoproxil fumarate (TDF), has reduced renal and bone toxicities while delivering comparable antiviral efficacy at a lower dose. This study aimed to identify factors associated with TAF switching within one year of its introduction in patients receiving TDF.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adult patients (≥18 years) with chronic hepatitis B who were receiving TDF on the day TAF became reimbursable in Korea, November 1, 2017. Antiviral prescriptions were tracked for one year to identify patients who switched to TAF. Switching rates were calculated as events per 100 person-months. Factors associated with TAF switching were evaluated using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Among 95,819 patients receiving TDF on the index date, 1.4 % switched to TAF within one year. Switching was more likely in males, older adults, and those with hypertension, renal disease, or bone disease. Use of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin II receptor blockers (ARBs) was associated with an increased likelihood of switching, whereas nonsteroidal anti-inflammatory drug use and the presence of hepatocellular carcinoma were associated with lower odds. Patients treated in Seoul and at tertiary hospitals had higher switching rates than those in other regions or healthcare settings.</div></div><div><h3>Conclusion</h3><div>In this nationwide cohort study, the TAF switching rate among patients receiving TDF was 1.4 % within one year of TAF's reimbursement approval in South Korea. Switching was significantly associated with renal disease, bone disease, age ≥60 years, hypertension, and ACEi/ARB use. Although the higher switching rate in patients with renal or bone disease aligns with reimbursement criteria, other at-risk groups not currently covered may benefit from earlier access.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102860"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Durations of fever and other symptoms among COVID-19 outpatients administered ensitrelvir during the 2023 Japanese XBB epidemic period","authors":"Naoki Kawai ,&nbsp;Takuma Bando ,&nbsp;Takeyuki Goto ,&nbsp;Shinro Matsuura ,&nbsp;Shin Nagao ,&nbsp;Osame Tanaka ,&nbsp;Takashi Kawashima ,&nbsp;Young Chong ,&nbsp;Hideyuki Ikematsu","doi":"10.1016/j.jiac.2025.102852","DOIUrl":"10.1016/j.jiac.2025.102852","url":null,"abstract":"<div><h3>Background</h3><div>This retrospective study evaluated factors influencing fever and symptom durations and the real-world effectiveness of ensitrelvir in mild to moderate COVID-19 outpatients during Japan's 2023 Omicron XBB epidemic.</div></div><div><h3>Methods</h3><div>Clinical data were collected via questionnaire. Multiple regression identified factors associated with fever and symptom durations. Durations were compared between patients treated with or without ensitrelvir using stratified analysis and three propensity score matchings (PSM): first (age, sex, vaccination, prior infection), second (fever ≥38 °C, ≥3 symptoms, ≥3 vaccine doses), and third (fatigue, sore throat, gastrointestinal symptoms).</div></div><div><h3>Results</h3><div>Data from 126 outpatients were analyzed: 85 received ensitrelvir, 41 did not. Ensitrelvir use and ≥3 vaccinations were independently associated with shorter fever duration. Median fever duration was significantly shorter with ensitrelvir (43 vs. 67 h, p = 0.0017). Stratified analysis showed shorter fever duration in patients with ≥38 °C (p = 0.0022) and shorter symptom duration with ≥3 symptoms (p = 0.031). Both durations remained significantly shorter after first (p &lt; 0.001; p = 0.011), second (p = 0.0044; p = 0.025), and third PSM (p = 0.0058; p = 0.015).</div></div><div><h3>Conclusions</h3><div>Ensitrelvir significantly shortened fever and symptom durations in mild to moderate COVID-19 outpatients. Patients with higher fever or more symptoms may benefit, even with repeated COVID-19 vaccination.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102852"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of cellular and humoral immunity against varicella-zoster virus in adult allogeneic hematopoietic cell transplant recipients: a cross-sectional study assessing cellular immunity after administration of an adjuvanted recombinant zoster vaccine","authors":"Takaaki Konuma ,&nbsp;Megumi Hamatani-Asakura ,&nbsp;Etsuko Nagai ,&nbsp;Seiko Kato ,&nbsp;Shohei Andoh ,&nbsp;Eisuke Adachi ,&nbsp;Maki Monna-Oiwa ,&nbsp;Satoshi Takahashi ,&nbsp;Hiroshi Yotsuyanagi ,&nbsp;Yasuhito Nannya","doi":"10.1016/j.jiac.2025.102857","DOIUrl":"10.1016/j.jiac.2025.102857","url":null,"abstract":"<div><h3>Background</h3><div>Allogeneic hematopoietic cell transplantation (HCT) recipients have a high risk of developing the reactivation of latent varicella-zoster virus (VZV), which is partly due to an attenuated cellular immunity. Recently, the adjuvanted recombinant zoster vaccine (RZV) has been demonstrated to be safe in allogeneic HCT recipients. However, evaluations of cellular and humoral immune responses to vaccination and reactivation in these populations remain limited.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional, comprehensive analysis of cellular immunity using a dual-color enzyme-linked immunosorbent spot (ELISpot) assay capable of detecting both interferon-gamma (IFN-γ) and interleukin-2 (IL-2)-secreting T cells in response to VZV glycoprotein E (gE) antigens in 44 allogeneic HCT recipients.</div></div><div><h3>Results</h3><div>The median interval from HCT to sample collection was 43 months (range, 9–220 months). Prior to sample collection, 16 patients received the RZV, whereas 20 patients experienced zoster reactivation after allogeneic HCT. The median anti-VZV IgG antibody level was 347.5 mIU/mL (range, 50–13,650 mIU/mL). ELISpot assays revealed that gE-specific IFN-γ- and IL-2-producing T cells were present in 60.0 % and 18.2 % of patients, respectively. Antibody levels did not correlate with the frequency of IFN-γ-producing T cells (r = 0.152, P = 0.324) or IL-2-producing T cells (r = 0.216, P = 0.157). Patients who experienced zoster reactivation and received vaccination had higher antibody levels and more frequent gE-specific IFN-γ-producing T cells compared to those without either.</div></div><div><h3>Conclusion</h3><div>Both zoster reactivation and vaccination were associated with enhanced cellular and humoral immunity against VZV in adult allogeneic HCT recipients.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102857"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echinocandin-resistant Candida albicans: A case report from Japan","authors":"Sayaka Hikida ,&nbsp;Yutaro Akiyama ,&nbsp;Masahiro Ishikane ,&nbsp;Hiroshi Shimazu ,&nbsp;Ryo Nasu ,&nbsp;Takayuki Shinohara ,&nbsp;Minoru Nagi ,&nbsp;Rei Shirai ,&nbsp;Makiko Onakado ,&nbsp;Nobuko Nakayama ,&nbsp;Yoshitsugu Miyazaki ,&nbsp;Akira Hangaishi ,&nbsp;Norio Ohmagari","doi":"10.1016/j.jiac.2025.102856","DOIUrl":"10.1016/j.jiac.2025.102856","url":null,"abstract":"<div><div>Echinocandin-resistant Candida albicans (<em>C. albicans</em>) is a rare but increasing global concern. In Japan, at least three cases had been confirmed by the end of 2015. Mutations in FKS cause echinocandin resistance in <em>Candida</em> species, which is primarily driven by previous echinocandin antifungal use. <em>C. albicans</em> resistance to echinocandins is raising clinicians' concerns globally and could pose a threat to Japan in the near future. The fungus is also an antimicrobial-resistant pathogen, raising awareness of the risk of resistance to prophylactic antifungals. Herein, we report a case of echinocandin-resistant <em>C. albicans</em> at our hospital. Mutations in the FKS gene that cause echinocandin resistance in <em>Candida</em> species have been detected.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102856"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145481878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of continuous hemodiafiltration on serum acyclovir concentrations in a patient with encephalopathy","authors":"Takahiro Ito ,&nbsp;Kotaro Itohara ,&nbsp;Sachi Hirata ,&nbsp;Takeshi Kimura ,&nbsp;Yumi Kitahiro ,&nbsp;Tomohiro Omura ,&nbsp;Joji Kotani ,&nbsp;Ikuko Yano","doi":"10.1016/j.jiac.2025.102859","DOIUrl":"10.1016/j.jiac.2025.102859","url":null,"abstract":"<div><div>Reports on serum acyclovir (ACV) concentrations in patients undergoing continuous hemodiafiltration (CHDF) remain limited. We present a case describing the impact of CHDF on serum ACV levels in a patient with encephalopathy. A Japanese woman in her 70s was prescribed oral valacyclovir (VACV) at a dose of 1000 mg three times daily for herpes zoster ophthalmicus. After 7 days of treatment, she was admitted to a local hospital with fever, dysarthria, altered consciousness, hallucinations, and headache. Her serum creatinine level was elevated at 4.02 mg/dL. Intravenous ACV was initiated under the clinical suspicion of varicella zoster virus (VZV) encephalitis. However, after 3 days of treatment without improvement in consciousness, she was transferred to our hospital. Her serum ACV concentration upon admission was 14.1 μg/mL. Suspecting ACV-induced encephalopathy and renal dysfunction, CHDF was promptly initiated. Following CHDF therapy, serum ACV levels declined rapidly, accompanied by a gradual improvement in consciousness. This case suggests that CHDF may be an effective therapeutic option for managing ACV-associated nephropathy and encephalopathy.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102859"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strain-specific anti-RBD IgG antibody titers against the WT, XBB.1.5, JN.1, and KP.3 strains consistently correlate with neutralizing activity following SARS-CoV-2 XBB.1.5-adapted mRNA vaccination","authors":"Takeyuki Goto ,&nbsp;Yong Chong ,&nbsp;Tomonori Sato ,&nbsp;Naoki Tani ,&nbsp;Shouta Saiki ,&nbsp;Satoru Ishida ,&nbsp;Naoki Kawai ,&nbsp;Takuma Bando ,&nbsp;Hideyuki Ikematsu","doi":"10.1016/j.jiac.2025.102842","DOIUrl":"10.1016/j.jiac.2025.102842","url":null,"abstract":"<div><h3>Introduction</h3><div>Data on the correlation between SARS-CoV-2 neutralizing activity and strain-specific anti-RBD IgG antibody (anti-RBD) titers is limited, particularly in the context of XBB.1.5-adapted vaccination.</div></div><div><h3>Methods</h3><div>A direct comparison of neutralizing activity, measured as 50 % neutralization (NT₅₀), and anti-RBD titers, measured using an ELISA, was conducted using serum samples collected in Japan before and after XBB.1.5-adapted mRNA vaccination.</div></div><div><h3>Results</h3><div>A total of 108 serum samples from 54 patients were analyzed. A strong correlation between neutralizing activity and anti-RBD titers was observed for the wild-type (WT), XBB.1.5, JN.1, and KP.3 strains (r = 0.94, 0.87, 0.86, and 0.82, respectively). This correlation persisted when stratifying pre- and post-vaccination samples (r = 0.92, 0.83, 0.85, and 0.82, respectively, for pre-vaccination samples and r = 0.96, 0.85, 0.82, and 0.75, respectively, for post-vaccination samples). Both NT₅₀ and anti-RBD titers significantly increased against all four tested strains after vaccination (<em>p</em> &lt; 0.001), with the highest fold change observed for the XBB.1.5 variant. Additionally, variant specificity, defined as the ratio of variant to WT values, significantly increased for XBB.1.5, JN.1, and KP.3 after vaccination in NT₅₀ and was also observed in anti-RBD titers.</div></div><div><h3>Conclusions</h3><div>These findings, demonstrating a strong correlation with neutralizing activity not only against the WT strain but also against the XBB.1.5, JN.1, and KP.3 variants, suggest that strain-specific anti-RBD IgG antibody titers would be useful as an indicator of humoral immunity following XBB.1.5-adapted vaccination.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102842"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emphysematous Esophagogastritis: a rare and life-threatening presentation of Streptococcus constellatus infection","authors":"Nguyen Sy Thau ,&nbsp;Hong Khanh Vu ,&nbsp;Thi Hoai Ngo ,&nbsp;Thi Thanh Nhan Pham ,&nbsp;Thu Trang Do ,&nbsp;Trong The Nguyen","doi":"10.1016/j.jiac.2025.102835","DOIUrl":"10.1016/j.jiac.2025.102835","url":null,"abstract":"<div><div>Emphysematous esophagogastritis (EEG) is a rare and potentially fatal infection of the upper gastrointestinal tract, marked by gas within the walls of the esophagus and stomach. It is typically associated with gas-forming organisms such as <em>K. pneumoniae, P. aeruginosa, S. aureus,</em> and <em>S. anginosus</em>; however, we report a unique case caused by <em>Streptococcus constellatus</em>, a species known for its aggressive tissue-invasive behavior but rarely implicated in EEG. A previously healthy adult presented with acute epigastric pain, fever, and septic shock. Computed tomography demonstrated diffuse intramural gas and wall thickening of both the esophagus and stomach, consistent with EEG. Blood cultures identified <em>S. constellatus</em> as the causative pathogen. The patient was managed conservatively with intravenous meropenem, proton pump inhibitors, bowel rest, and intensive supportive care. The patient made a complete clinical recovery without requiring surgery in the acute phase. However, a delayed complication, gastric outlet obstruction due to an antral-pyloric stricture, developed during follow-up and necessitated surgical correction. This case underscores the critical importance of early diagnosis, coordinated multidisciplinary care, and prolonged follow-up in managing EEG, and highlights <em>Streptococcus constellatus</em> as a rare but highly invasive pathogen in this life-threatening condition.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102835"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and external validation of a population pharmacokinetic model and optimal Vancomycin dosing regimen for overweight and obese patients","authors":"Toshiaki Komatsu ,&nbsp;Atsushi Tomizawa ,&nbsp;Masaru Samura ,&nbsp;Ayako Suzuki ,&nbsp;Tomoyuki Ishigo ,&nbsp;Satoshi Fujii ,&nbsp;Yuta Ibe ,&nbsp;Hiroaki Yoshida ,&nbsp;Hiroaki Tanaka ,&nbsp;Hisato Fujihara ,&nbsp;Fumihiro Yamaguchi ,&nbsp;Fumiya Ebihara ,&nbsp;Takumi Maruyama ,&nbsp;Yusuke Yagi ,&nbsp;Yukihiro Hamada ,&nbsp;Fumio Nagumo ,&nbsp;Akitoshi Takuma ,&nbsp;Hiroaki Chiba ,&nbsp;Yoshifumi Nishi ,&nbsp;Yuki Igarashi ,&nbsp;Kazuaki Matsumoto","doi":"10.1016/j.jiac.2025.102838","DOIUrl":"10.1016/j.jiac.2025.102838","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to develop and evaluate a population pharmacokinetic model and optimal dosing regimen for vancomycin in overweight and obese adults.</div></div><div><h3>Methods</h3><div>A population pharmacokinetic model using a two-compartment system was constructed using a nonlinear mixed-effects approach, incorporating 527 data points from 184 participants. External validation of the model was carried out using an additional 55 data points from 21 participants; these were not used in the construction of the model. Monte Carlo simulations were used to determine the dosage that achieved the steady state area under the curve value falling between 400 μg h/mL and 600 μg h/mL.</div></div><div><h3>Results</h3><div>In the final model, vancomycin clearance was found to be a significant predictor of blood vancomycin levels, alongside creatinine clearance (CCr), blood urea nitrogen levels, and incidence of heart failure. CCr was calculated with adjusted body weight (AdjBW). AdjBW was selected as a predictor of the volume of distribution in the central and peripheral compartments. External validation showed that the highest proportion of cases had deviations of less than 15 % between measured and predicted values in the final model developed in this study. This indicates that our model outperforms previously developed models (five for obese patients and four for non-obese patients).</div></div><div><h3>Conclusions</h3><div>Our model shows that determining effective vancomycin doses for overweight and obese patients depend on estimated CCr rates, AdjBW, BUN levels, and incidence of heart failure.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102838"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}