title: Empiric guideline-recommended weight-based vancomycin dosing and mortality in methicillin-resistant Staphylococcus aureus bacteremia: a retrospective cohort study.
abstract: BACKGROUND
  No studies have evaluated the effect of guideline-recommended weight-based dosing on in-hospital mortality of patients with methicillin-resistant Staphylococcus aureus bacteremia.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Empiric use of weight-based, guideline-recommended empiric vancomycin dosing was not associated with reduced mortality in this multicenter study.
authors.affiliation: Department of Pharmacy Practice, Texas Tech University Health Sciences Center, School of Pharmacy, Dallas, TX, USA. ronald.hall@ttuhsc.edu
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Hall
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Giuliano
authors.forename: Krystal K
authors.initials: KK
authors.lastname: Haase
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Hazlewood
authors.forename: Chistopher R
authors.initials: CR
authors.lastname: Frei
authors.forename: Nicolas A
authors.initials: NA
authors.lastname: Forcade
authors.forename: Sara D
authors.initials: SD
authors.lastname: Brouse
authors.forename: Todd
authors.initials: T
authors.lastname: Bell
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Bedimo
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Alvarez
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*; D014894:Weights and Measures
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin