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

BMC Infectious Diseases

Research Article

Todd Bell¹  Roger J Bedimo²  Krystal K Haase³  Christopher A Giuliano⁴  Ronald G Hall⁵  Carlos A Alvarez⁵  Kathleen A Hazlewood⁶  Sara D Brouse⁷  Chistopher R Frei⁸  Nicolas A Forcade⁹ 

[1] Department of Internal Medicine, Texas Tech University Health Sciences Center, School of Medicine, Amarillo, USA;Department of Internal Medicine, University of Texas Southwestern, Dallas, USA;Department of Pharmacy Practice, Texas Tech University Health Sciences Center, School of Pharmacy, Amarillo, USA;Department of Pharmacy Practice, Texas Tech University Health Sciences Center, School of Pharmacy, Amarillo, USA;Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, USA;Department of Pharmacy Practice, Texas Tech University Health Sciences Center, School of Pharmacy, Dallas, USA;Department of Clinical Sciences, University of Texas Southwestern, Dallas, USA;Department of Pharmacy Practice, Texas Tech University Health Sciences Center, School of Pharmacy, Dallas, USA;Swedish Family Medicine Residency Program, University of Wyoming School of Pharmacy, Englewood, USA;Department of Pharmacy Practice, Texas Tech University Health Sciences Center, School of Pharmacy, Dallas, USA;University of Kentucky Healthcare, Lexington, USA;Division of Pharmacotherapy, University of Texas, Austin, USA;Division of Pharmacotherapy, University of Texas, Austin, USA;Mission Regional Medical Center, Mission, USA;

关键词: Weight;    Obesity;    Efficacy;    MRSA;    Vancomycin;    Bacteremia;   

DOI  :  10.1186/1471-2334-12-104

 received in 2011-12-02, accepted in 2012-04-27,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundNo studies have evaluated the effect of guideline-recommended weight-based dosing on in-hospital mortality of patients with methicillin-resistant Staphylococcus aureus bacteremia.MethodsThis was a multicenter, retrospective, cohort study of patients with methicillin-resistant Staphylococcus aureus bacteremia receiving at least 48 hours of empiric vancomycin therapy between 01/07/2002 and 30/06/2008. We compared in-hospital mortality for patients treated empirically with weight-based, guideline-recommended vancomycin doses (at least 15 mg/kg/dose) to those treated with less than 15 mg/kg/dose. We used a general linear mixed multivariable model analysis with variables identified a priori through a conceptual framework based on the literature.ResultsA total of 337 patients who were admitted to the three hospitals were included in the cohort. One-third of patients received vancomycin empirically at the guideline-recommended dose. Guideline-recommended dosing was not associated with in-hospital mortality in the univariable (16% vs. 13%, OR 1.26 [95%CI 0.67-2.39]) or multivariable (OR 0.71, 95%CI 0.33-1.55) analysis. Independent predictors of in-hospital mortality were ICU admission, Pitt bacteremia score of 4 or greater, age 53 years or greater, and nephrotoxicity.ConclusionsEmpiric use of weight-based, guideline-recommended empiric vancomycin dosing was not associated with reduced mortality in this multicenter study.

【 授权许可】

CC BY   
© Hall et al.; licensee BioMed Central Ltd. 2012