title: Teicoplanin therapy for MRSA bacteraemia: a retrospective study emphasizing the importance of maintenance dosing in improving clinical outcomes.
abstract: OBJECTIVE
  To study the relationship between teicoplanin maintenance dosing and clinical outcomes in adults with MRSA bacteraemia.
  
  
  METHODS
  MRSA bacteraemic patients who received three teicoplanin loading doses (6 mg/kg/12 h) followed by maintenance doses of 6 mg/kg/24 h (Group 1) or 6 mg/kg/12 h (Group 2) were retrospectively analysed. Evaluated on day 7, an unfavourable early clinical response referred to the presence of septic shock, persistent fever, persistent leucocytosis and/or persistent bacteraemia. Assessed at completion of teicoplanin therapy, an unfavourable final clinical response referred to clinical treatment failure.
  
  
  RESULTS
  Compared with those in Group 1 (n = 122), patients in Group 2 (n = 82) had significantly higher rates of favourable early clinical response (P = 0.040) and final clinical response (P < 0.001) and a lower bloodstream-infection-related mortality rate (P = 0.018). Based on estimated ORs for favourable final clinical response in multivariate analysis, endocarditis (P < 0.001; OR 0.109, 95% CI 0.032-0.368), pneumonia (P < 0.001; OR 0.172, 95% CI 0.069-0.433), ICU admission (P < 0.001; OR 0.132, 95% CI 0.054-0.325) and high Pittsburgh bacteraemia score (P = 0.042; OR 0.187, 95% CI 0.021-0.457) were each a risk factor for an unfavourable final clinical response. Higher teicoplanin maintenance dosing contributed to a favourable final clinical response (P < 0.001; OR 8.800, 95% CI 3.602-21.502). Significantly higher favourable final clinical response rates were also found in patients with endocarditis (P = 0.007) and pneumonia (P < 0.001) in Group 2 compared with their counterparts in Group 1.
  
  
  CONCLUSIONS
  These data highlight the importance of higher teicoplanin maintenance dosing, especially for severe infections due to MRSA.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chen-Hsiang
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Ching-Yen
authors.initials: CY
authors.lastname: Tsai
authors.affiliation: Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Chia-Chin
authors.initials: CC
authors.lastname: Li
authors.affiliation: Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Chien
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan Chang Gung University College of Medicine, Kaohsiung, Taiwan 88b0@cgmh.org.tw jwliu@cgmh.org.tw.
authors.forename: Jien-Wei
authors.initials: JW
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D060046:Maintenance Chemotherapy / Q000379:methods*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D017334:Teicoplanin / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin
keywords: clinical responses; higher dosing; mortality; risk factors