Clinical outcomes after initial treatment of methicillin-resistant <em>Staphylococcus aureus</em> infections

Abstract

ObjectiveTo evaluate the clinical outcomes associated with anti-methicillin-resistant Staphylococcus aureus (MRSA) antimicrobials.MethodsWe reviewed a prospective database of 247 consecutive patients with clinically and microbiologically confirmed MRSA infections, hospitalized in 7 Japanese hospitals between April 2014 and March 2015, and treated with anti-MRSA pharmaceuticals. Survival was measured at 30 days. We examined the relationships between initial antimicrobial administered and survival and organ toxicity. HR and 95% CIs were calculated.ResultsOverall 30-day mortality was 12%. The lungs were infected in 105 (41%), skin and soft tissue in 73 (30%), and bones and joints in 21 (9%) patients. Bacteremia complicated the illness in 69 patients (28%). Among 5 pharmaceuticals, vancomycin was prescribed to 174 (71%), linezolid to 38 (16%), teicoplanin to 22 (9%), and daptomycin to 11 (5%) patients. Vancomycin tended to be associated with the lowest survival (HR=2.47; 95% CI=0.93–6.51; P=0.067), particularly in the lung-infected subgroup (HR=4.85; 95% CI=1.12–20.94; P=0.034) after adjustments for baseline illness severity. The incidence of renal dysfunction tended to be higher in patients with trough serum concentrations of vancomycin >15 mg/dL.ConclusionIn this observational study reflecting real-world conditions, vancomycin was associated with higher 30-day mortality and incidence of kidney dysfunction than other anti-MRSA agents. The significance of the differences observed among antimicrobials other than vancomycin is uncertain.

The monitoring of vancomycin: a systematic review and meta-analyses of area under the concentration-time curve-guided dosing and trough-guided dosing

“…1a). Of these, 86 articles were further examined in detail, and finally, eight studies [18][19][20][21][22][23][24][25] were included in the meta-analysis for effectiveness evaluation, 16 studies [9,20,[26][27][28][29][30][31][32][33][34][35][36][37][38][39] were included in the meta-analysis for safety evaluation, and one study was included in both analyses (Kullar 2011).…”

“… Fujii 2013 [ 29 ] Retrospective Japan 2011 > 18 Median (range), SD: 64 (21–88), 14.2 Percentage of MRSA is not available. Highest Trough levels determined 3 days after the initiation of vancomycin therapy Ley 2013 [ 30 ] Retrospective America 2006–2010 ≥18 Mean ± SD: 50 ± 22.6 Percentage of MRSA is not available: Trauma. Trough levels drawn 1 h prior to the subsequent dose Barriere 2014 [ 31 ] Retrospective 38 countries 2005–2007 ≥18 Mean ± SD: 64.7 ± 16.2 MRSA pneumonia (78%): S. aureus nosocomial pneumonia, multilobar pneumonia, bacteremia.…”

Clinical Practice Guidelines for Therapeutic Drug Monitoring of Vancomycin in the Framework of Model-Informed Precision Dosing: A Consensus Review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring

“…For the evaluation of different PK monitoring strategies, two studies assessing effectiveness ( n = 326) [ 18 , 19 ] and four studies assessing safety ( n = 1902) [ 18 , 19 , 20 , 21 ] were selected for meta-analyses. For the evaluation of vancomycin trough concentrations, effectiveness was assessed at a cut-off of 10 (two studies, n = 393) [ 22 , 23 ] or 15 µg/mL (eight studies, n = 849) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], and safety was assessed through a comparison of 10–15 and <10 µg/mL (14 studies, n = 1637) [ 22 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ], through a comparison of 15–20 and 10–15 µg/mL (12 studies, n = 1211) [ 22 , 30 , 31 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], and through a comparison of ≥20 and 15–20 µg/mL (14 studies, n = 1127) [ 22 , 30 ...…”

Clinical predictors of nephrotoxicity associated with teicoplanin: Meta‐analysis and meta‐regression

“…Finally, eight articles from three databases that met the inclusion criteria were analysed for this meta-analysis, involving 634 patients who had received teicoplanin (Figure 1). [14][15][16][17][18][19][20][21] Among the eight articles, 15 datasets were constructed. We confirmed that the same patients were not duplicated in multiple subgroups.…”