Risk Factors for Treatment Failure in Patients Receiving Vancomycin for Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Pneumonia

被引:13
作者
Aston, Jonathan L. [1 ]
Dortch, Marcus J. [1 ,2 ]
Dossett, Lesly A. [2 ]
Creech, C. Buddy [3 ]
May, Addison K. [2 ]
机构
[1] Vanderbilt Univ, Med Ctr, Dept Pharmaceut Serv, Nashville, TN 37232 USA
[2] Vanderbilt Univ, Med Ctr, Dept Surg, Div Trauma & Surg Crit Care, Nashville, TN 37232 USA
[3] Vanderbilt Univ, Med Ctr, Dept Pediat, Div Pediat Infect Dis, Nashville, TN 37232 USA
关键词
VENTILATOR-ASSOCIATED PNEUMONIA; CARE-ASSOCIATED PNEUMONIA; 2; DOUBLE-BLIND; NOSOCOMIAL PNEUMONIA; MORTALITY; EFFICACY; OUTCOMES; INFECTIONS; THERAPY; MRSA;
D O I
10.1089/sur.2008.100
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: The rate of vancomycin failure in patients with hospital-acquired pneumonia (HAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) has exceeded 40% in several studies. This observation was attributed initially to the lack of weight-based dosing and targeting of lower trough concentrations. However, a subsequent study demonstrated no additional benefit in patients who achieved trough vancomycin concentrations >15 mg/L compared with patients with concentrations between 5 and 15 mg/L. We sought to identify contributors to vancomycin failure in patients with MRSA HAP. Methods: This was a retrospective study of patients in a surgical intensive care unit with MRSA HAP who received vancomycin between January 1, 2005, and July 31, 2007. Clinical outcomes, microbiological data, prior antibiotic exposure, ventilator days, co-morbidities, and demographics were compared in patients with clinical success and those with treatment failure. Their characteristics were compared using a two-sided Fisher exact test or Mann-Whitney U test, as appropriate for nominal or continuous data. Results: More patients in the treatment failure group had received one or more doses of vancomycin within 90 days leading up to M RSA HAP (84% vs. 47%; p = 0.04). In addition, the duration of prior vancomycin exposure was significantly longer among patients in the treatment failure group (6 vs. 0 days; p < 0.05). There were no statistically significant differences in the percentages of patients who achieved a vancomycin trough concentrations >= 15 mg/dL within the first 48 h (28% vs. 17%; p = 0.69), 72 h (44% vs. 39%; p = 1.0), or 96 h (56% vs. 44%; p = 0.74) after starting treatment. Patients in the failure group had a significantly higher overall mortality rate (32% vs. 0; p = 0.02). Conclusions: These data suggest that patients who have recent exposure to vancomycin are at high risk for vancomycin failure and may benefit from an appropriate alternative when a diagnosis of MRSA HAP is made.
引用
收藏
页码:21 / 28
页数:8
相关论文
共 26 条
[11]   Linezolid in VAP by MRSA: a better choice? [J].
Ioanas, M ;
Lode, H .
INTENSIVE CARE MEDICINE, 2004, 30 (03) :343-346
[12]   Predictors of mortality for methicillin-resistant Staphylococcus aureus health-care-associated pneumonia -: Specific evaluation of vancomycin pharmacokinetic indices [J].
Jeffres, Meghan N. ;
Isakow, Warren ;
Doherty, Joshua A. ;
McKinnon, Peggy S. ;
Ritchie, David J. ;
Micek, Scott T. ;
Kollef, Marin H. .
CHEST, 2006, 130 (04) :947-955
[13]   Clinical cure and survival in Gram-positive ventilator-associated pneumonia: retrospective analysis of two double-blind studies comparing linezolid with vancomycin [J].
Kollef, MH ;
Rello, J ;
Cammarata, SK ;
Croos-Dabrera, RV ;
Wunderink, RG .
INTENSIVE CARE MEDICINE, 2004, 30 (03) :388-394
[14]   Methicillin-resistant S. aureus ventilator-associated pneumonia:: Strategies to prevent and treat [J].
Lam, Anna P. ;
Wunderink, Richard G. .
SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, 2006, 27 (01) :92-103
[15]  
*LIN LAB STAND I, 2007, M100S17 CLIN LAB STA, V27, P1
[16]   Relationship between vancomycin MIC and failure among patients with methicillin-resistant Staphylococcus aureus bacteremia treated with vancomycin [J].
Lodise, T. P. ;
Graves, J. ;
Evans, A. ;
Graffunder, E. ;
Helmecke, M. ;
Lomaestro, B. M. ;
Stellrecht, K. .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2008, 52 (09) :3315-3320
[17]   Point:: Vancomycin is not obsolete for the treatment of infection caused by methicillin-resistant Staphylococcus aureus [J].
Mohr, John F. ;
Murray, Barbara E. .
CLINICAL INFECTIOUS DISEASES, 2007, 44 (12) :1536-1542
[18]   Area under the inhibitory curve and a pneumonia scoring system for predicting outcomes of vancomycin therapy for respiratory infections by Staphylococcus aureus [J].
Moise, PA ;
Forrest, A ;
Bhavnani, SM ;
Birmingham, MC ;
Schentag, JJ .
AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY, 2000, 57 (20) :S4-S9
[19]   Epidemiology and outcomes of ventilator-associated pneumonia in a large US database [J].
Rello, J ;
Ollendorf, DA ;
Oster, G ;
Vera-Llonch, M ;
Bellm, L ;
Redman, R ;
Kollef, MH .
CHEST, 2002, 122 (06) :2115-2121
[20]   Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia [J].
Sakoulas, G ;
Moise-Broder, PA ;
Schentag, J ;
Forrest, A ;
Moellering, RC ;
Eliopoulos, GM .
JOURNAL OF CLINICAL MICROBIOLOGY, 2004, 42 (06) :2398-2402