Impact of empiric weight-based vancomycin dosing on nephrotoxicity and mortality in geriatric patients with methicillin-resistant Staphylococcus aureus bacteraemia

R. G. Hall, A. T. Blaszczyk, K. A. Thompson, S. D. Brouse, C. A. Giuliano, C. R. Frei, N. A. Forcade, E. M. Mortensen, T. Bell, R. J. Bedimo, C. A. Alvarez

Research output: Contribution to journalArticle

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Abstract

What is known and objective: Few studies have evaluated the effect of vancomycin dosing on the health outcomes in geriatric patients. Data are needed to determine whether higher vancomycin dosing strategies are more effective in geriatric patients and/or lead to excessive rates of adverse events. Methods: This study used a subset of patients aged ≥65 years from a multicentre, retrospective, cohort study of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. Patients received ≥ 48 h of empiric vancomycin between 1 July 2002 and 30 June 2008. We compared the incidence of nephrotoxicity and in-hospital mortality in patients who received guideline-recommended dosing (at least 15 mg/kg/dose) to patients who received lower dosing. Multivariable generalized mixed-effect models were constructed to determine independent risk factors for nephrotoxicity and in-hospital mortality. Results and discussion: Half of the cohort (46% of 92 patients) received guideline-recommended dosing. Empiric use of weight-based dosing did increase the percentage of patients achieving a vancomycin trough ≥ 15 mg/L (57% vs. 42%). Nephrotoxicity occurred in 32% of patients and 26% died during their hospitalization. Guideline-recommended dosing was not associated with significant changes in nephrotoxicity (OR 1.13; 95% CI 0.40-3.19) or in-hospital mortality (OR 1.14; 95% CI 0.41-3.18) in the multivariable analysis. What is new and conclusion: In this study of geriatric patients, guideline-recommended dosing was not associated with significant changes in nephrotoxicity or mortality. As 40% of the patients who received guideline-recommended dosing failed to achieve a target vancomycin trough of ≥ 15 mg/L, future studies should focus on dosing strategies to increase target attainment rate.

Original languageEnglish (US)
Pages (from-to)653-657
Number of pages5
JournalJournal of Clinical Pharmacy and Therapeutics
Volume39
Issue number6
DOIs
StatePublished - Dec 1 2014

Fingerprint

Vancomycin
Methicillin-Resistant Staphylococcus aureus
Bacteremia
Geriatrics
Weights and Measures
Mortality
Guidelines
Hospital Mortality
Hospitalization
Cohort Studies
Retrospective Studies

Keywords

  • Antibiotics
  • Evidence-based medicine
  • Mortality
  • Nephrotoxicity
  • Obesity
  • Vancomycin

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology

Cite this

Impact of empiric weight-based vancomycin dosing on nephrotoxicity and mortality in geriatric patients with methicillin-resistant Staphylococcus aureus bacteraemia. / Hall, R. G.; Blaszczyk, A. T.; Thompson, K. A.; Brouse, S. D.; Giuliano, C. A.; Frei, C. R.; Forcade, N. A.; Mortensen, E. M.; Bell, T.; Bedimo, R. J.; Alvarez, C. A.

In: Journal of Clinical Pharmacy and Therapeutics, Vol. 39, No. 6, 01.12.2014, p. 653-657.

Research output: Contribution to journalArticle

Hall, R. G. ; Blaszczyk, A. T. ; Thompson, K. A. ; Brouse, S. D. ; Giuliano, C. A. ; Frei, C. R. ; Forcade, N. A. ; Mortensen, E. M. ; Bell, T. ; Bedimo, R. J. ; Alvarez, C. A. / Impact of empiric weight-based vancomycin dosing on nephrotoxicity and mortality in geriatric patients with methicillin-resistant Staphylococcus aureus bacteraemia. In: Journal of Clinical Pharmacy and Therapeutics. 2014 ; Vol. 39, No. 6. pp. 653-657.
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AU - Thompson, K. A.

AU - Brouse, S. D.

AU - Giuliano, C. A.

AU - Frei, C. R.

AU - Forcade, N. A.

AU - Mortensen, E. M.

AU - Bell, T.

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