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The association of vancomycin trough levels with outcomes among patients with methicillin-resistant Staphylococcus aureus (MRSA) infections: Retrospective cohort study

INTRODUCTION: Current guidelines recommend maintaining vancomycin trough concentrations between 15–20 mg/L for serious methicillin resistant staphylococcus aureus (MRSA) infections. This recommendation is based on limited evidence. METHODS: A retrospective study including patients with vancomycin su...

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Autores principales: Yahav, Dafna, Abbas, Maria, Nassar, Laila, Ghrayeb, Alia, Kurnik, Daniel, Shepshelovich, Daniel, Leibovici, Leonard, Paul, Mical
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448937/
https://www.ncbi.nlm.nih.gov/pubmed/30946754
http://dx.doi.org/10.1371/journal.pone.0214309
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author Yahav, Dafna
Abbas, Maria
Nassar, Laila
Ghrayeb, Alia
Kurnik, Daniel
Shepshelovich, Daniel
Leibovici, Leonard
Paul, Mical
author_facet Yahav, Dafna
Abbas, Maria
Nassar, Laila
Ghrayeb, Alia
Kurnik, Daniel
Shepshelovich, Daniel
Leibovici, Leonard
Paul, Mical
author_sort Yahav, Dafna
collection PubMed
description INTRODUCTION: Current guidelines recommend maintaining vancomycin trough concentrations between 15–20 mg/L for serious methicillin resistant staphylococcus aureus (MRSA) infections. This recommendation is based on limited evidence. METHODS: A retrospective study including patients with vancomycin susceptible MRSA infections (MIC< = 2 mg/L), treated with vancomycin. We compared outcomes among patients attaining high (> = 15mg/L) vs low (<15mg/L) trough vancomycin levels. We used a propensity score to matching patients achieving low and high levels and conducted an adjusted analysis in the propensity score (PS)-matched cohort using regression analysis. Primary outcome was 30-day all-cause mortality. RESULTS: Among 285 patients included, there were no significant differences between patients achieving high and low vancomycin levels in mortality (46/131, 35.1% vs 41/154, 26.6%), clinical success, microbiological success, or nephrotoxicity. Similarly, in the PS-matched cohort (n = 162), there was no significant difference in mortality between patients with high and low vancomycin levels (24/53, 45.3% vs 57/109, 52.3%, respectively), adjusted odds ratio for mortality with high levels 0.63 (95% confidence interval 0.28–1.43). In both cohorts, patients with pneumonia achieving high levels had significantly higher clinical and microbiological success (PS-matched cohort: clinical success: 16/32, 50.0% vs 5/27, 18.5%, p = 0.012; microbiological success: 19/32, 59.4% vs 7/27, 25.9%, p = 0.010), without significant differences in mortality. CONCLUSIONS: We found no association between vancomycin levels > = 15 mg/L and clinical outcomes in patients with MRSA infections. In patients with MRSA pneumonia, vancomycin levels > = 15 mg/L were associated with higher clinical success rates. Further larger cohort studies are needed to define optimal vancomycin levels according to the site of infection.
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spelling pubmed-64489372019-04-19 The association of vancomycin trough levels with outcomes among patients with methicillin-resistant Staphylococcus aureus (MRSA) infections: Retrospective cohort study Yahav, Dafna Abbas, Maria Nassar, Laila Ghrayeb, Alia Kurnik, Daniel Shepshelovich, Daniel Leibovici, Leonard Paul, Mical PLoS One Research Article INTRODUCTION: Current guidelines recommend maintaining vancomycin trough concentrations between 15–20 mg/L for serious methicillin resistant staphylococcus aureus (MRSA) infections. This recommendation is based on limited evidence. METHODS: A retrospective study including patients with vancomycin susceptible MRSA infections (MIC< = 2 mg/L), treated with vancomycin. We compared outcomes among patients attaining high (> = 15mg/L) vs low (<15mg/L) trough vancomycin levels. We used a propensity score to matching patients achieving low and high levels and conducted an adjusted analysis in the propensity score (PS)-matched cohort using regression analysis. Primary outcome was 30-day all-cause mortality. RESULTS: Among 285 patients included, there were no significant differences between patients achieving high and low vancomycin levels in mortality (46/131, 35.1% vs 41/154, 26.6%), clinical success, microbiological success, or nephrotoxicity. Similarly, in the PS-matched cohort (n = 162), there was no significant difference in mortality between patients with high and low vancomycin levels (24/53, 45.3% vs 57/109, 52.3%, respectively), adjusted odds ratio for mortality with high levels 0.63 (95% confidence interval 0.28–1.43). In both cohorts, patients with pneumonia achieving high levels had significantly higher clinical and microbiological success (PS-matched cohort: clinical success: 16/32, 50.0% vs 5/27, 18.5%, p = 0.012; microbiological success: 19/32, 59.4% vs 7/27, 25.9%, p = 0.010), without significant differences in mortality. CONCLUSIONS: We found no association between vancomycin levels > = 15 mg/L and clinical outcomes in patients with MRSA infections. In patients with MRSA pneumonia, vancomycin levels > = 15 mg/L were associated with higher clinical success rates. Further larger cohort studies are needed to define optimal vancomycin levels according to the site of infection. Public Library of Science 2019-04-04 /pmc/articles/PMC6448937/ /pubmed/30946754 http://dx.doi.org/10.1371/journal.pone.0214309 Text en © 2019 Yahav et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Yahav, Dafna
Abbas, Maria
Nassar, Laila
Ghrayeb, Alia
Kurnik, Daniel
Shepshelovich, Daniel
Leibovici, Leonard
Paul, Mical
The association of vancomycin trough levels with outcomes among patients with methicillin-resistant Staphylococcus aureus (MRSA) infections: Retrospective cohort study
title The association of vancomycin trough levels with outcomes among patients with methicillin-resistant Staphylococcus aureus (MRSA) infections: Retrospective cohort study
title_full The association of vancomycin trough levels with outcomes among patients with methicillin-resistant Staphylococcus aureus (MRSA) infections: Retrospective cohort study
title_fullStr The association of vancomycin trough levels with outcomes among patients with methicillin-resistant Staphylococcus aureus (MRSA) infections: Retrospective cohort study
title_full_unstemmed The association of vancomycin trough levels with outcomes among patients with methicillin-resistant Staphylococcus aureus (MRSA) infections: Retrospective cohort study
title_short The association of vancomycin trough levels with outcomes among patients with methicillin-resistant Staphylococcus aureus (MRSA) infections: Retrospective cohort study
title_sort association of vancomycin trough levels with outcomes among patients with methicillin-resistant staphylococcus aureus (mrsa) infections: retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448937/
https://www.ncbi.nlm.nih.gov/pubmed/30946754
http://dx.doi.org/10.1371/journal.pone.0214309
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