Friday, February 25, 2011

Vancomycin MIC and outcomes in MRSA pneumonia

From a recent article in Chest:

Methods: Adult patients in ICUs with a diagnosis of MRSA HAP, VAP, or HCAP were entered in the study....

Results: The study sample consisted of 158 patients. All-cause mortality at day 28 was 32.3%. The majority of MRSA isolates had a vancomycin MIC greater than or equal to 1.5 mg/mL (115/158, 72.8%). Propensity score analysis demonstrated an increase in 28-day mortality as vancomycin MIC increased from 0.75 to 3 mg/mL (P less than or equal to .001)....
Conclusions: Mortality in patients with MRSA HAP, VAP, and HCAP increases as a function of the vancomycin MIC, even for strains with MIC values within the susceptible range. Evaluation of vancomycin MICs should be contemplated at the institutional level and for individual cases of MRSA pneumonia. The use of vancomycin therapy in patients with MRSA pneumonia caused by isolates with MICs between 1 and 2 mg/mL should be undertaken with caution, and alternative therapies should be considered.

We've seen several papers to this effect before, which I blogged here.

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