Treatment of methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia with high-dose vancomycin or linezolid

Leslie Hamilton, G Christopher Wood, Louis J. Magnotti, Martin Croce, Julie B. Martin, Joseph Swanson, Bradley Boucher, Timothy Fabian

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11 Citations (Scopus)

Abstract

BACKGROUND: The purpose of this study was to determine the clinical cure rate of high-dose vancomycin for the treatment of methicillinresistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia (VAP) in critically ill trauma patients. Recent trials suggest that a traditional dose of 1 g q12 hours results in unacceptable cure rates for MRSA VAP. Thus, more aggressive vancomycin dosing has the potential to improve efficacy. Based on pharmacokinetic principles, the goal initial dose at the study center has been 20 mg/kg q12 hours or q8 hours since the 1990s. METHODS: All patients admitted to the trauma intensive care unit from 1997 to 2008 diagnosed with MRSAVAP were retrospectively reviewed. Diagnosis required bacterial growth Q100,000 colony forming units/mL from a bronchoscopic bronchoalveolar lavage, new or changing infiltrate, plus at least two of the following: fever, leukocytosis or leukopenia, or purulent sputum. RESULTS: Overall, 125 patients with 141 episodes of MRSA VAP were identified. Mean age was 47 years ± 21 years, median Injury Severity Score was 29 (22-43), 70% of patients were male, and the mean length of intensive care unit stay was 38 days T 35 days. The mean initial vancomycin dosewas 18.1 mg/kg/dose with a mean duration of therapy of 11 days. Clinical success was achieved in 88% (125 of 131) of episodes, with microbiological success in 89% (66 of 74) of episodes with a follow-up bronchoscopic bronchoalveolar lavage. Overall mortality was 20% (25 of 125), with death due to VAP in 12 of 25 deaths. Mean initial vancomycin trough concentrations were 10.6 mg/L in the clinical success group and 13.3 mg/L in the clinical failure group ( p = not significant). CONCLUSIONS: High-dose vancomycin provided an acceptable cure rate for MRSAVAP in critically ill trauma patients.

Original languageEnglish (US)
Pages (from-to)1478-1483
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume72
Issue number6
DOIs
StatePublished - Jun 1 2012

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Linezolid
Staphylococcal Pneumonia
Ventilator-Associated Pneumonia
Vancomycin
Methicillin-Resistant Staphylococcus aureus
Bronchoalveolar Lavage
Critical Illness
Intensive Care Units
Wounds and Injuries
Therapeutics
Injury Severity Score
Leukocytosis
Leukopenia
Sputum
Fever
Stem Cells
Pharmacokinetics

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

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title = "Treatment of methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia with high-dose vancomycin or linezolid",
abstract = "BACKGROUND: The purpose of this study was to determine the clinical cure rate of high-dose vancomycin for the treatment of methicillinresistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia (VAP) in critically ill trauma patients. Recent trials suggest that a traditional dose of 1 g q12 hours results in unacceptable cure rates for MRSA VAP. Thus, more aggressive vancomycin dosing has the potential to improve efficacy. Based on pharmacokinetic principles, the goal initial dose at the study center has been 20 mg/kg q12 hours or q8 hours since the 1990s. METHODS: All patients admitted to the trauma intensive care unit from 1997 to 2008 diagnosed with MRSAVAP were retrospectively reviewed. Diagnosis required bacterial growth Q100,000 colony forming units/mL from a bronchoscopic bronchoalveolar lavage, new or changing infiltrate, plus at least two of the following: fever, leukocytosis or leukopenia, or purulent sputum. RESULTS: Overall, 125 patients with 141 episodes of MRSA VAP were identified. Mean age was 47 years ± 21 years, median Injury Severity Score was 29 (22-43), 70{\%} of patients were male, and the mean length of intensive care unit stay was 38 days T 35 days. The mean initial vancomycin dosewas 18.1 mg/kg/dose with a mean duration of therapy of 11 days. Clinical success was achieved in 88{\%} (125 of 131) of episodes, with microbiological success in 89{\%} (66 of 74) of episodes with a follow-up bronchoscopic bronchoalveolar lavage. Overall mortality was 20{\%} (25 of 125), with death due to VAP in 12 of 25 deaths. Mean initial vancomycin trough concentrations were 10.6 mg/L in the clinical success group and 13.3 mg/L in the clinical failure group ( p = not significant). CONCLUSIONS: High-dose vancomycin provided an acceptable cure rate for MRSAVAP in critically ill trauma patients.",
author = "Leslie Hamilton and Wood, {G Christopher} and Magnotti, {Louis J.} and Martin Croce and Martin, {Julie B.} and Joseph Swanson and Bradley Boucher and Timothy Fabian",
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T1 - Treatment of methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia with high-dose vancomycin or linezolid

AU - Hamilton, Leslie

AU - Wood, G Christopher

AU - Magnotti, Louis J.

AU - Croce, Martin

AU - Martin, Julie B.

AU - Swanson, Joseph

AU - Boucher, Bradley

AU - Fabian, Timothy

PY - 2012/6/1

Y1 - 2012/6/1

N2 - BACKGROUND: The purpose of this study was to determine the clinical cure rate of high-dose vancomycin for the treatment of methicillinresistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia (VAP) in critically ill trauma patients. Recent trials suggest that a traditional dose of 1 g q12 hours results in unacceptable cure rates for MRSA VAP. Thus, more aggressive vancomycin dosing has the potential to improve efficacy. Based on pharmacokinetic principles, the goal initial dose at the study center has been 20 mg/kg q12 hours or q8 hours since the 1990s. METHODS: All patients admitted to the trauma intensive care unit from 1997 to 2008 diagnosed with MRSAVAP were retrospectively reviewed. Diagnosis required bacterial growth Q100,000 colony forming units/mL from a bronchoscopic bronchoalveolar lavage, new or changing infiltrate, plus at least two of the following: fever, leukocytosis or leukopenia, or purulent sputum. RESULTS: Overall, 125 patients with 141 episodes of MRSA VAP were identified. Mean age was 47 years ± 21 years, median Injury Severity Score was 29 (22-43), 70% of patients were male, and the mean length of intensive care unit stay was 38 days T 35 days. The mean initial vancomycin dosewas 18.1 mg/kg/dose with a mean duration of therapy of 11 days. Clinical success was achieved in 88% (125 of 131) of episodes, with microbiological success in 89% (66 of 74) of episodes with a follow-up bronchoscopic bronchoalveolar lavage. Overall mortality was 20% (25 of 125), with death due to VAP in 12 of 25 deaths. Mean initial vancomycin trough concentrations were 10.6 mg/L in the clinical success group and 13.3 mg/L in the clinical failure group ( p = not significant). CONCLUSIONS: High-dose vancomycin provided an acceptable cure rate for MRSAVAP in critically ill trauma patients.

AB - BACKGROUND: The purpose of this study was to determine the clinical cure rate of high-dose vancomycin for the treatment of methicillinresistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia (VAP) in critically ill trauma patients. Recent trials suggest that a traditional dose of 1 g q12 hours results in unacceptable cure rates for MRSA VAP. Thus, more aggressive vancomycin dosing has the potential to improve efficacy. Based on pharmacokinetic principles, the goal initial dose at the study center has been 20 mg/kg q12 hours or q8 hours since the 1990s. METHODS: All patients admitted to the trauma intensive care unit from 1997 to 2008 diagnosed with MRSAVAP were retrospectively reviewed. Diagnosis required bacterial growth Q100,000 colony forming units/mL from a bronchoscopic bronchoalveolar lavage, new or changing infiltrate, plus at least two of the following: fever, leukocytosis or leukopenia, or purulent sputum. RESULTS: Overall, 125 patients with 141 episodes of MRSA VAP were identified. Mean age was 47 years ± 21 years, median Injury Severity Score was 29 (22-43), 70% of patients were male, and the mean length of intensive care unit stay was 38 days T 35 days. The mean initial vancomycin dosewas 18.1 mg/kg/dose with a mean duration of therapy of 11 days. Clinical success was achieved in 88% (125 of 131) of episodes, with microbiological success in 89% (66 of 74) of episodes with a follow-up bronchoscopic bronchoalveolar lavage. Overall mortality was 20% (25 of 125), with death due to VAP in 12 of 25 deaths. Mean initial vancomycin trough concentrations were 10.6 mg/L in the clinical success group and 13.3 mg/L in the clinical failure group ( p = not significant). CONCLUSIONS: High-dose vancomycin provided an acceptable cure rate for MRSAVAP in critically ill trauma patients.

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