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Original Research: CRITICAL CARE MEDICINE |

Predictors of Mortality for Methicillin-Resistant Staphylococcus aureus Health-Care–Associated Pneumonia*: Specific Evaluation of Vancomycin Pharmacokinetic Indices

Meghan N. Jeffres, PharmD; Warren Isakow, MD; Joshua A. Doherty, BS; Peggy S. McKinnon, PharmD; David J. Ritchie, PharmD; Scott T. Micek, PharmD; Marin H. Kollef, MD, FCCP
Author and Funding Information

*From the Department of Pharmacy (Drs. Jeffres, McKinnon, Ritchie, and Micek), Barnes-Jewish Hospital, St. Louis, MO; the Department of Pulmonary and Critical Care Medicine (Drs. Isakow and Kollef), Washington University School of Medicine, St. Louis, MO; and Medical Informatics (Mr. Doherty), BJC Healthcare, St. Louis, MO.

Correspondence to: Marin H. Kollef, MD, FCCP, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8052, St. Louis, MO 63110; e-mail: mkollef@im.wustl.edu



Chest. 2006;130(4):947-955. doi:10.1378/chest.130.4.947
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Objective: The goal of this investigation was to determine whether vancomycin pharmacokinetic indexes (eg, serum trough concentrations or area under the concentration curve [AUC] values) were associated with mortality for patients with health-care–associated pneumonia (HCAP) attributed to methicillin-resistant Staphylococcus aureus (MRSA).

Design: A retrospective, single-center, observational cohort study.

Setting: Barnes-Jewish Hospital, a 1,200-bed urban teaching facility.

Patients: Adult patients requiring hospitalization who were identified as having HCAP attributed to MRSA by BAL semi-quantitative cultures.

Interventions: Retrospective data collection from automated hospital, microbiology, and pharmacy databases.

Measurements and main results: One hundred two patients with MRSA HCAP were identified over a 6.5-year period. Thirty-two patients (31.4%) died during their hospitalization. The mean (± SD) vancomycin trough concentrations (13.6 ± 5.9 vs 13.9 ± 6.7 μg/mL, respectively; p = 0.866) and AUC values (351 ± 143 vs 354 ± 109 μg/h/mL, respectively; p = 0.941) did not differ between survivors and nonsurvivors. The stratification of the vancomycin trough concentrations and AUC values yielded no relationship with hospital mortality.

Conclusions: We found no evidence that greater vancomycin trough concentrations or AUC values correlated with hospital outcome. Based on these results, aggressive dosing strategies for vancomycin (eg, trough concentrations of > 15 μg/mL) may not offer any advantage over traditional dose targets (range, 5 to 15 μg/mL).

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