Vancomycin AUC/MIC ratio and 30-day mortality in patients with Staphylococcus aureus bacteremia

A ratio of the vancomycin area under the concentration-time curve to the MIC (AUC/MIC) of ≥ 400 has been associated with clinical success when treating Staphylococcus aureus pneumonia, and this target was recommended by recently published vancomycin therapeutic monitoring consensus guidelines for treating all serious S. aureus infections. Here, vancomycin serum trough levels and vancomycin AUC/MIC were evaluated in a "real-world" context by following a cohort of 182 patients with S. aureus bacteremia (SAB) and analyzing these parameters within the critical first 96 h of vancomycin therapy. The median vancomycin trough level at this time point was 19.5 mg/liter. There was a significant difference in vancomycin AUC/MIC when using broth microdilution (BMD) compared with Etest MIC (medians of 436.1 and 271.5, respectively; P373, derived using classification and regression tree analysis, was associated with reduced mortality (P=0.043) and remained significant in a multivariable model. This study demonstrated that we obtained vancomycin trough levels in the target therapeutic range early during the course of therapy and that obtaining a higher vancomycin AUC/MIC (in this case, >373) within 96 h was associated with reduced mortality. The MIC test method has a significant impact on vancomycin AUC/MIC estimation. Clinicians should be aware that the current target AUC/MIC of ≥400 was derived using the reference BMD method, so adjustments to this target need to be made when calculating AUC/MIC ratio using other MIC testing methods. Copyrigh

Pokemon Stadium

Pokemon Stadium game cartridge for the Nintendo 64 (N64)

Super Smash Bros.

Super Smash Bros. game cartridge for the Nintendo 64 (N64)

Unraveling The Mortal Coil: Death And Stories Of Play

The current conversation on death in digital games focuses on the split between screen death and narrative death. At the same time, players telling stories about games often have nuanced conversations regarding the term. The result is a discussion around death in games that could be clearer. In this paper, I will untangle the various ways that players use this term \u27death\u27 in their own accounts of play. Using one hundred player stories drawn from the Skyrim user community as a test case, this discussion demonstrates ways that players explore death in their own reflective storytelling regarding play