Empiric guideline-recommended weight-based vancomycin dosing and mortality in methicillin-resistant Staphylococcus aureus bacteremia: a retrospective cohort study

Hall, Ronald G.; Giuliano, Christopher; Haase, Krystal K.; Hazlewood, Kathleen A.; Frei, Christopher R.; Forcade, Nicolas A.; Brouse, Sara D.; Bell, Todd; Bedimo, Roger; Álvarez, Carlos A.

doi:10.1186/1471-2334-12-104

Cited by 26 publications

(28 citation statements)

References 16 publications

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“…The in-hospital mortality rate of HA-MRSA bacteremia in the VAN and TEC treatment groups of this study were 33.6% and 37.5%, respectively, which is comparable to the range of 14% to 60% reported previously in other studies (3,(24)(25)(26). Based on the Charlson comorbidity index or Pitt's bacteremia score, the clinical severity of the infections of the patients in our study was comparable to that of health care-associated and community-acquired MRSA infections (14,26).…”

Section: Discussionsupporting

confidence: 76%

“…Based on the Charlson comorbidity index or Pitt's bacteremia score, the clinical severity of the infections of the patients in our study was comparable to that of health care-associated and community-acquired MRSA infections (14,26). In addition, 4 risk factors for clinical failure of HA-MRSA bacteremia, namely, Pitt's bacteremia score, acute renal injury, duration of fever, and bacteremia, were not different from those reported previously (26)(27)(28)(29).…”

Section: Discussionsupporting

confidence: 51%

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Multicenter Prospective Observational Study of the Comparative Efficacy and Safety of Vancomycin versus Teicoplanin in Patients with Health Care-Associated Methicillin-Resistant Staphylococcus aureus Bacteremia

Yoon

Park²,

Kim

et al. 2014

Antimicrob Agents Chemother

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pThe purpose of this study was to compare the clinical efficacy and safety of vancomycin to those of teicoplanin for the treatment of adult patients with health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) bacteremia. A multicenter observational study was prospectively conducted in 15 teaching hospitals in Korea between February 2010 and July 2011. Adult patients (>18 years old) with HA-MRSA bacteremia who were initially treated with vancomycin (VAN) (n ‫؍‬ 134) or teicoplanin (TEC) (n ‫؍‬ 56) were enrolled. Clinical and microbiological responses and drug-related adverse events were compared between the two treatment groups using univariate and multivariate logistic regression analyses. The vancomycin and teicoplanin MICs were determined by Etest. The MRSA-related mortality, duration of fever, and duration of MRSA bacteremia in the treatment groups were not significantly different. There was no significant difference in the occurrence of drug-related adverse events. Among the 190 MRSA isolates, the VAN MICs ranged from 0.5 to 2 g/ml (MIC 50 and MIC 90 , 1.5 g/ml), and the TEC MIC ranged from 0.5 to 8 g/ml (MIC 50 , 3 g/ml; MIC 90 , 6 g/ml). In multivariate analyses, the antibiotic type (vancomycin or teicoplanin) was not associated with treatment outcomes. This study indicates that teicoplanin is an effective and safe alternative to vancomycin for the treatment of HA-MRSA bacteremia.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 51%

Multicenter Prospective Observational Study of the Comparative Efficacy and Safety of Vancomycin versus Teicoplanin in Patients with Health Care-Associated Methicillin-Resistant Staphylococcus aureus Bacteremia

Yoon

Park²,

Kim

et al. 2014

Antimicrob Agents Chemother

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“…3,4 Three institutions were utilized for the study which included a 400 bed tertiary hospital, a 350 bed Veterans Affairs hospital, and a 600 bed university hospital. We identified those who were hospitalized between July 2002 and June 2008.…”

Section: Methodsmentioning

confidence: 99%

“…A 45% nephrotoxicity rate and a 30% in-hospital mortality rate were expected given the results of previous studies. 3,4 We determined that four variables could be included in the multivariable model for nephrotoxicity and three variables in a multivariable model for mortality. One hundred patients would be required for the multivariable analyses according to these assumptions to have 5–10 events per variable included to avoid over fitting the multivariable model.…”

Section: Methodsmentioning

confidence: 99%

“…We have previously observed of those who receive vancomycin, patients older than 53 years of age are at a higher risk of death, and those above 52 years of age have an increased rate of nephrotoxicity regardless of the dosing regimen used. 3,4 However, few investigators have evaluated the effect of vancomycin dosing on the outcomes of geriatric patients. The Infectious Diseases Society of America (IDSA), American Society of Health-Systems Pharmacists (ASHP), and the Society of Infectious Diseases Pharmacists (SIDP) currently recommend that all adults with normal renal function receive weight-based dosing (15–20 mg/kg every 8–12 hours) of vancomycin.…”

Section: What Is Known and Objectivementioning

confidence: 99%

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Impact of empiric weight-based vancomycin dosing on nephrotoxicity and mortality in geriatric patients with methicillin-resistant Staphylococcus aureus bacteraemia

et al. 2014

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What is known and objective Few studies have evaluated the effect of vancomycin dosing on the health outcomes in geriatric patients. Data are needed to determine if higher vancomycin dosing strategies are more effective in geriatric patients and/or lead to excessive rates of adverse events. Methods This study used a subset of patients ages ≥ 65 years from a multicenter, retrospective, cohort study of methicillin resistant Staphylococcus aureus (MRSA) bacteremia. Patients received ≥ 48 hours of empiric vancomycin between 07/01/2002 and 06/30/2008. We compared the incidence of nephrotoxicity and in-hospital mortality in patients who received guideline-recommended dosing (at least 15 mg/kg/dose) to patients who received lower dosing. Multivariable generalized mixed effects models were constructed to determine independent risk factors for nephrotoxicity and in-hospital mortality. Results and discussion Half of the cohort (46% of 92 patients) received guideline-recommended dosing. Empiric use of weight-based dosing did increase the percentage of patients achieving a vancomycin trough ≥ 15 mg/L (57% vs. 42%). Nephrotoxicity occurred in 32% of patients and 26% died during their hospitalization. Guideline-recommended dosing was not associated with significant changes in nephrotoxicity (OR 1.03; 95% CI 0.38–2.82) or in-hospital mortality (OR 1.01; 95% CI 0.40–2.54) in the multivariable analysis. What is new and conclusion In this study of geriatric patients, guideline-recommended dosing was not associated with significant changes in nephrotoxicity or mortality. Since 40% of the patients who received guideline-recommended dosing failed to achieve a target vancomycin trough of ≥ 15 mg/L, future studies should focus on dosing strategies to increase target attainment rate.

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Clinical Management ofStaphylococcus aureusBacteremia

Holland

Arnold

Fowler

2014

JAMA

376

261

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Importance Several management strategies may improve outcomes in patients with Staphylococcus aureus bacteremia (SAB). The strength of evidence supporting these management strategies, however, varies widely. Objective To perform a systematic review of the evidence for two unresolved questions involving management strategies for SAB: 1) is transesophageal echocardiography (TEE) necessary in all cases of SAB; and 2) what is the optimal antibiotic therapy for methicillin resistant Staphylococcus aureus (MRSA) bacteremia? Evidence acquisition A PubMed search from inception through May 2014 was performed to find studies that addressed the role of TEE in SAB. A second search of PubMed, EMBASE, and The Cochrane Library from 1/1/1990 to 5/28/2014 was performed to find studies that addressed antibiotic treatment of MRSA bacteremia. Studies that reported outcomes of systemic antibiotic therapy for MRSA bacteremia were included. All searches were augmented by review of bibliographic references from included studies. The quality of evidence was assessed using the GRADE system by consensus of independent evaluations by at least two authors. Results In 9 studies with a total of 3513 patients, use of TEE was associated with higher rates of diagnosis of endocarditis (14–25%) when compared with TTE (2–14%). Five studies proposed criteria to identify patients in whom TEE might safely be avoided. Only one high-quality trial of antibiotic therapy for MRSA bacteremia was identified from the 83 studies considered. Conclusions and relevance Most contemporary management strategies for SAB are based upon low quality evidence. TEE is indicated in most patients with SAB. It may be possible to identify a subset of SAB patients for whom TEE can be safely avoided. Vancomycin and daptomycin are the first-line antibiotic choices for MRSA bacteremia. Well-designed studies to address the management of SAB are desperately needed.

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Empiric guideline-recommended weight-based vancomycin dosing and mortality in methicillin-resistant Staphylococcus aureus bacteremia: a retrospective cohort study

Cited by 26 publications

References 16 publications

Multicenter Prospective Observational Study of the Comparative Efficacy and Safety of Vancomycin versus Teicoplanin in Patients with Health Care-Associated Methicillin-Resistant Staphylococcus aureus Bacteremia

Multicenter Prospective Observational Study of the Comparative Efficacy and Safety of Vancomycin versus Teicoplanin in Patients with Health Care-Associated Methicillin-Resistant Staphylococcus aureus Bacteremia

Impact of empiric weight-based vancomycin dosing on nephrotoxicity and mortality in geriatric patients with methicillin-resistant Staphylococcus aureus bacteraemia

Clinical Management ofStaphylococcus aureusBacteremia

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