Empiric guideline-recommended weight-based vancomycin dosing and nephrotoxicity rates in patients with methicillin-resistant Staphylococcus aureus bacteremia a retrospective cohort study.docVIP

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Empiric guideline-recommended weight-based vancomycin dosing and nephrotoxicity rates in patients with methicillin-resistant Staphylococcus aureus bacteremia a retrospective cohort study.doc

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Empiric guideline-recommended weight-based vancomycin dosing and nephrotoxicity rates in patients with methicillin-resistant Staphylococcus aureus bacteremia a retrospective cohort study

Halletal.BMCPharmacologyandToxicology2013,14:12 /2050-6511/14/12 RESEARCH ARTICLE OpenAccess Empiricguideline-recommendedweight-based vancomycindosingandnephrotoxicityratesin patientswithmethicillin-resistantStaphylococcus aureusbacteremia:aretrospectivecohortstudy RonaldGHallII1,2*,KathleenAHazlewood1,7,SaraDBrouse1,8,ChristopherAGiuliano3,9,KrystalKHaase3, ChistopherRFrei4,NicolasAForcade4,10,ToddBell5,RogerJBedimo6andCarlosAAlvarez1,2 Abstract Background:Previousstudieshaveestablishedacorrelationbetweenvancomycintroughsandnephrotoxicity. However,dataarecurrentlylackingregardingtheeffectofguideline-recommendedweight-baseddosingon nephrotoxicityinmethicillin-resistantStaphylococcusaureusbacteremia(MRSAB). Methods:Adultswhowereatleast18yearsofagewithmethicillin-resistantStaphylococcusaureusbacteremiaand receivedofempiricvancomycintherapyforatleast48hours(01/07/2002and30/06/2008)wereincludedinthis multicenter,retrospectivecohortstudy.Theassociationbetweenguideline-recommended,weight-based vancomycindosing(atleast15mg/kg/dose)andnephrotoxicity(increaseinserumcreatinine(SCr)bymorethan 0.5mg/dloratleasta50%increasefrombaselineonatleasttwoconsecutivelaboratorytests)wasevaluated. Potentialindependentassociationswereevaluatedusingamultivariablegenerallinearmixed-effectmodel. Results:Overall,23%ofpatientsdevelopednephrotoxicity.Thirty-fourpercentofthe337patientswhometstudy criteriareceivedweight-baseddosing.Thecohortwascomposedof69%maleswithamedianageof55years.The mostcommonsourcesofMRSABincludedskin/softtissue(32%),catheter-relatedbloodstreambacteremia(20%), pulmonary(18%).Eighty-sixpercentofpatientsreceivedtwicedailydosing.Similarratesofnephrotoxicitywere observedregardlessofthereceiptofguideline-recommendeddosing(22%vs.24%,OR0.91[95%CI0.53-1.56]).This findingwasconfirmedinthemultivariableanalysis(OR1.52[95%CI0.75-3.08]). Independentpredictorsof nephrotoxicitywere(OR,95%CI)vancomycindurationofgreaterthan15days(3.36,1.79-6.34),weightover100kg (2.74,1.27-5.91),Pittb