Abstract
High vancomycin serum trough is not associated with reduction of mortality in methicillin-resistant Staphylococcus aureus bloodstream infections
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) is an important cause of morbidity and mortality with a 30-day all-cause mortality of up to 30% [1,2,3,4,5]
The current Infectious Diseases Society of America (IDSA) and the American Society of Health-System Pharmacists (ASHP) guidelines recommend a vancomycin loading dose of 25 to 30 mg/kg and target serum trough concentration of 15 to 20 mg/L in patients with MRSA BSI [6,7]. The rationale for these recommendations is based on a combination of evidence including outcomes using the ratio of the vancomycin area under the curve (AUC) to minimum inhibitory concentration (MIC) [AUC/minimum inhibitory concentrations (MICs)], clinical failure in patients with susceptible MRSA strains with higher vancomycin MICs, and inability to achieve target AUC/ MIC in strains with higher MICs from earlier recommended therapy [6,7,8,9,10,11,12,13,14]
This study demonstrated no impact on MRSA BSI mortality rates after the 2010 implementation of IDSA/ASHP guidelines for vancomycin use
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) is an important cause of morbidity and mortality with a 30-day all-cause mortality of up to 30% [1,2,3,4,5]. The current Infectious Diseases Society of America (IDSA) and the American Society of Health-System Pharmacists (ASHP) guidelines recommend a vancomycin loading dose of 25 to 30 mg/kg and target serum trough concentration of 15 to 20 mg/L in patients with MRSA BSI [6,7] The rationale for these recommendations is based on a combination of evidence including outcomes using the ratio of the vancomycin area under the curve (AUC) to minimum inhibitory concentration (MIC) [AUC/MIC], clinical failure in patients with susceptible MRSA strains with higher vancomycin MICs, and inability to achieve target AUC/ MIC in strains with higher MICs from earlier recommended therapy [6,7,8,9,10,11,12,13,14]. The first reported vancomycinintermediate S. aureus (VISA) and vancomycin-resistant S. aureus (VRSA) emerged from Detroit [16]
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