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* From the Department of Pharmacy (Drs. Jeffres, McKinnon, Ritchie, and Micek), Barnes-Jewish Hospital, St. Louis, MO; the Department of Pulmonary and Critical Care Medicine (Drs. Isakow and Kollef), Washington University School of Medicine, St. Louis, MO; and Medical Informatics (Mr. Doherty), BJC Healthcare, St. Louis, MO.
Correspondence to: Marin H. Kollef, MD, FCCP, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8052, St. Louis, MO 63110; e-mail: mkollef{at}im.wustl.edu
Abstract
Objective: The goal of this investigation was to determine whether vancomycin pharmacokinetic indexes (eg, serum trough concentrations or area under the concentration curve [AUC] values) were associated with mortality for patients with health-care–associated pneumonia (HCAP) attributed to methicillin-resistant Staphylococcus aureus (MRSA).
Design: A retrospective, single-center, observational cohort study.
Setting: Barnes-Jewish Hospital, a 1,200-bed urban teaching facility.
Patients: Adult patients requiring hospitalization who were identified as having HCAP attributed to MRSA by BAL semi-quantitative cultures.
Interventions: Retrospective data collection from automated hospital, microbiology, and pharmacy databases.
Measurements and main results: One hundred two patients with MRSA HCAP were identified over a 6.5-year period. Thirty-two patients (31.4%) died during their hospitalization. The mean (± SD) vancomycin trough concentrations (13.6 ± 5.9 vs 13.9 ± 6.7 µg/mL, respectively; p = 0.866) and AUC values (351 ± 143 vs 354 ± 109 µg/h/mL, respectively; p = 0.941) did not differ between survivors and nonsurvivors. The stratification of the vancomycin trough concentrations and AUC values yielded no relationship with hospital mortality.
Conclusions: We found no evidence that greater vancomycin trough concentrations or AUC values correlated with hospital outcome. Based on these results, aggressive dosing strategies for vancomycin (eg, trough concentrations of > 15 µg/mL) may not offer any advantage over traditional dose targets (range, 5 to 15 µg/mL).
Key Words: antibiotics • methicillin resistance • pneumonia • Staphylococcus aureus
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