Predictors of mortality for methicillin-resistant Staphylococcus aureus health-care-associated pneumonia: specific evaluation of vancomycin pharmacokinetic indices.
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).


METHODS
A retrospective, single-center, observational cohort study.


METHODS
Barnes-Jewish Hospital, a 1,200-bed urban teaching facility.


METHODS
Adult patients requiring hospitalization who were identified as having HCAP attributed to MRSA by BAL semi-quantitative cultures.


METHODS
Retrospective data collection from automated hospital, microbiology, and pharmacy databases.


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 microg/mL, respectively; p = 0.866) and AUC values (351 +/- 143 vs 354 +/- 109 microg/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 microg/mL) may not offer any advantage over traditional dose targets (range, 5 to 15 microg/mL).
Jeffres
Meghan N
MN
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, USA.
Isakow
Warren
W
Doherty
Joshua A
JA
McKinnon
Peggy S
PS
Ritchie
David J
DJ
Micek
Scott T
ST
Kollef
Marin H
MH
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D019540:Area Under Curve; D001682:Biological Availability; D015331:Cohort Studies; D003428:Cross Infection / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D008923:Missouri; D011023:Pneumonia, Staphylococcal / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000187:drug effects*; D016019:Survival Analysis; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics*
D000900:Anti-Bacterial Agents; D014640:Vancomycin