Relationship between vancomycin exposure and outcomes among patients with MRSA bloodstream infections with vancomycin Etest(R) MIC values of 1.5mg/L: A pilot study.
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Issue Date
2017-07
Authors
Martirosov, Dmitriy M
Bidell, Monique R
Pai, Manjunath P
Scheetz, Marc H
Rosenkranz, Susan L
Lodise, Thomas P
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Abstract
Data suggest that vancomycin is less effective for methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) with vancomycin Etest(R) MIC (MICEtest) >/=1.5 mg/L. No published studies have evaluated the relationship between vancomycin exposure and outcomes among patients with MRSA BSIs vancomycin MICEtest >/=1.5 mg/L. This study was a retrospective cohort of 71 hospitalized, adult, non-dialysis patients with MRSA BSIs treated with vancomycin. All but three patients had a vancomycin MICEtest of 1.5 mg/L. Achievement of CART-derived AUC24-48h of at least 550 mg*h/L (AUC24-48h/MIC of 366 mg*h/L) was associated with a lower incidence of treatment failure. In multivariate analyses, the risk ratio was 0.45 for the CART-derived AUC24-48h threshold, indicating that achievement of the CART-derived AUC24-48h threshold of 550 was associated with a 2-fold decrease in treatment failure. These findings suggest a potential association between vancomycin exposure and outcomes in patients with MRSA BSIs with MICEtest >/=1.5 mg/L. As this study was retrospective, these findings provide the basis for a future large-scale, multi-center prospective study.
Citation
Martirosov DM, Bidell MR, Pai MP, Scheetz MH, Rosenkranz SL, Lodise TP. Relationship between vancomycin exposure and outcomes among patients with MRSA bloodstream infections with vancomycin Etest® MIC values of 1.5mg/L: A pilot study. Diagn Microbiol Infect Dis. 2017 Jul;88(3):259-263. doi: 10.1016/j.diagmicrobio.2017.03.008. Epub 2017 Apr 2. PMID: 28449844; PMCID: PMC5512425.
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R15 AI105742/AI/NIAID NIH HHS/United States