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Open Access Highly Accessed Research article

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

Ronald G Hall12*, Christopher A Giuliano39, Krystal K Haase3, Kathleen A Hazlewood17, Chistopher R Frei4, Nicolas A Forcade104, Sara D Brouse18, Todd Bell5, Roger J Bedimo6 and Carlos A Alvarez12

Author Affiliations

1 Department of Pharmacy Practice, Texas Tech University Health Sciences Center, School of Pharmacy, Dallas, USA

2 Department of Clinical Sciences, University of Texas Southwestern, Dallas, USA

3 Department of Pharmacy Practice, Texas Tech University Health Sciences Center, School of Pharmacy, Amarillo, USA

4 Division of Pharmacotherapy, University of Texas, Austin, USA

5 Department of Internal Medicine, Texas Tech University Health Sciences Center, School of Medicine, Amarillo, USA

6 University of Texas Southwestern, Department of Internal Medicine, Dallas, USA

7 University of Wyoming School of Pharmacy, Swedish Family Medicine Residency Program, Englewood, USA

8 University of Kentucky Healthcare, Lexington, USA

9 Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, USA

10 Mission Regional Medical Center, Mission, USA

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BMC Infectious Diseases 2012, 12:104  doi:10.1186/1471-2334-12-104

Published: 27 April 2012

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.

Keywords:
Weight; Obesity; Efficacy; MRSA; Vancomycin; Bacteremia