Empiric guideline-recommended weight-based vancomycin dosing and mortality in methicillin-resistant Staphylococcus aureus bacteremia: A retrospective cohort study

Ronald G. Hall, Christopher A. Giuliano, Krystal K. Haase, Kathleen A. Hazlewood, Chistopher R. Frei, Nicolas A. Forcade, Sara D. Brouse, Todd Bell, Roger J. Bedimo, Carlos A. Alvarez

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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.

Original languageEnglish (US)
Article number104
JournalBMC Infectious Diseases
Volume12
DOIs
StatePublished - Apr 27 2012

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Keywords

  • Bacteremia
  • Efficacy
  • MRSA
  • Obesity
  • Vancomycin
  • Weight

ASJC Scopus subject areas

  • Infectious Diseases

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