Journal Article

Impact of Vancomycin Exposure on Outcomes in Patients With Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia: Support for Consensus Guidelines Suggested Targets

Ravina Kullar, Susan L. Davis, Donald P. Levine and Michael J. Rybak

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 52, issue 8, pages 975-981
Published in print April 2011 | ISSN: 1058-4838
Published online April 2011 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1093/cid/cir124
Impact of Vancomycin Exposure on Outcomes in Patients With Methicillin-Resistant Staphylococcus aureus Bacteremia: Support for Consensus Guidelines Suggested Targets

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(See the article by Patel et al, on pages 969–974.)

Background. High rates of vancomycin failure in methicillin-resistant Staphylococcus aureus (MRSA) infections have been increasingly reported over time. The primary objective of our study was to determine the impact of vancomycin exposure and outcomes in patients with MRSA bacteremia initially treated with vancomycin.

Methods. This was a single-center retrospective analysis of 320 patients with documented MRSA bacteremia initially treated with vancomycin from January 2005 through April 2010. Two methods of susceptibility, Etest and broth microdilution, were performed for all isolates to determine the correlation of susceptibility testing to patient outcomes.

Results. Among a cohort of 320 patients, more than half (52.5%) experienced vancomycin failure. Independent predictors of vancomycin failure in logistic regression included infective endocarditis (adjusted odds ratio [AOR], 4.55; 95% confidence interval [CI], 2.26–9.15), nosocomial-acquired infection (AOR, 2.19; 95% CI, 1.21–3.97), initial vancomycin trough <15 mg/L (AOR, 2.00; 95% CI, 1.25–3.22), and vancomycin minimum inhibitory concentration (MIC) >1 mg/L by Etest (AOR, 1.52; 95% CI, 1.09–2.49). With use of Classification and Regression Tree (CART) analysis, patients with vancomycin area under the curve at 24 h (AUC24h) to MIC ratios <421 were found to have significantly higher rates of failure, compared with patients with AUC24h to MIC ratios >421 (61.2% vs 48.6%; P = .038)

Conclusions. In light of the high failure rates associated with this antimicrobial, optimizing the pharmacokinetic/pharmacodynamic properties of vancomycin by targeting higher trough values of 15–20 mg/L and AUC24h/MIC ratios ≥400 in selected patients should be considered.

Journal Article.  3765 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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