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

Abstract

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.

Vancomycin Trough Concentration as a Predictor of Clinical Outcomes in Patients withStaphylococcus aureusBacteremia: A Meta-analysis of Observational Studies

“…Of 377 studies retrieved from the PubMed query and two studies retrieved from bibliographic review, only 14 studies ultimately met the criteria to be incorporated into the final analyses ( Figure 1). 8,[13][14][15][16][17][18][19][20][21][22][23][24][25] These studies were published from 2011 to 2014, with 1677 unique patients representing geriatric 19 and unspecified inpatients ( Table 1). 8,[13][14][15][16][17][18][20][21][22][23][24][25] Treatment failure was an outcome of seven studies, all of which used a definition of treatment failure that included mortality and persistent bacteremia.…”

Relationship Between Mean Vancomycin Trough Concentration and Mortality in Critically Ill Patients: A Multicenter Retrospective Study

“…Two retrospective studies have shown that VTC alone is not a good indicator for vancomycin treatment success among patients with MRSA bacteremia ( Jung et al, 2014 ; Makmor-Bakry et al, 2019 ). Two other retrospective cohort studies have demonstrated that VTC >15 mg/L fails to improve the outcomes of patients with MRSA infections ( Clemens et al, 2011 ; Hall et al, 2014 ). Additionally, two prospective, multicenter, observational studies have demonstrated no significant association between VTC level and vancomycin treatment response in a Chinese population diagnosed with gram-positive bacterial infections ( Liang et al, 2018 ; Shen et al, 2018 ).…”

Relationship Between Mean Vancomycin Trough Concentration and Mortality in Critically Ill Patients: A Multicenter Retrospective Study

“…Two retrospective studies have shown that VTC alone is not a good indicator for vancomycin treatment success among patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia [7,8]. Two other retrospective cohort studies have demonstrated that VTC > 15 mg/L fails to improve the outcomes of patients with MRSA infection [17,18]. Additionally, two prospective, multicenter, observational studies have demonstrated no signi cant association between VTC level and vancomycin treatment response in a Chinese population diagnosed with gram-positive bacterial infections [11,19].…”