European journal of hospital pharmacy : science and practice · 2025
Treatment outcomes in methicillin-resistant Staphylococcus aureus bacteraemia patients receiving vancomycin: a retrospective study at a tertiary hospital.
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Fann Zi Yin, Othman Ezazaya, Chong Siew Ling, Mohd Saffian Shamin
Аннотация
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia remains a major clinical challenge with high mortality, despite guideline-recommended vancomycin therapy. Although a ratio of the area under the curve to the minimum inhibitory concentration (AUC/MIC) ≥400 mg·hour/L is advocated for efficacy, the association between pharmacokinetic/pharmacodynamic (PK/PD) target attainment and clinical outcomes remains uncertain.
OBJECTIVE: To determine the in-hospital mortality rate among patients with MRSA bacteraemia receiving vancomycin. The secondary objectives were to (1) evaluate the association between patient characteristics and in-hospital mortality, (2) examine the relationship between in-hospital mortality and secondary treatment outcomes, and (3) assess the impact of vancomycin AUC/MIC target attainment on in-hospital mortality.
METHODS: A retrospective cohort study was conducted at a tertiary hospital in Malaysia involving adults with MRSA bacteraemia treated from 2014 to 2024. AUC/MIC data were analysed for patients receiving intermittent vancomycin dosing. Multivariable logistic regression identified independent predictors of mortality.
RESULTS: Among 148 patients included, the in-hospital mortality rate was 32.4% (n=48/148). Four factors were independently associated with in-hospital mortality: organ failure (adjusted OR (aOR) 19.28, 95% CI 5.14 to 72.26), recent antibiotic exposure (aOR 5.24, 95% CI 1.90 to 14.51), hypoalbuminaemia <30 g/L (aOR 4.56, 95% CI 1.69 to 13.06) and cerebrovascular disease (aOR 4.24, 95% CI 1.15 to 15.60). Subgroup analysis of patients on intermittent dosing revealed six independent predictors of in-hospital mortality: cerebrovascular disease (aOR 26.9, 95% CI 2.76 to 261.98), hypoalbuminaemia <30 g/L (aOR 10.68, 95% CI 1.54 to 74.29), organ failure (aOR 48.15, 95% CI 4.27 to 542.81), polymicrobial bacteraemia (aOR 24.28, 95% CI 3.09 to 190.64), persistent bacteraemia (aOR 90.08, 95% CI 2.85 to 2845.83) and intensive care unit admission (aOR 0.09, 95% CI 0.01 to 0.91), the latter showing a protective effect. Only 22.2% (n=26/117) achieved the target AUC/MIC, which was not significantly linked to mortality reduction.
CONCLUSIONS: Vancomycin AUC/MIC attainment was suboptimal, and mortality was primarily influenced by host factors and disease severity. Early risk stratification and timely intervention are critical to improve outcomes and guide resource prioritisation, particularly in settings with limited access to AUC-guided dosing.
OBJECTIVE: To determine the in-hospital mortality rate among patients with MRSA bacteraemia receiving vancomycin. The secondary objectives were to (1) evaluate the association between patient characteristics and in-hospital mortality, (2) examine the relationship between in-hospital mortality and secondary treatment outcomes, and (3) assess the impact of vancomycin AUC/MIC target attainment on in-hospital mortality.
METHODS: A retrospective cohort study was conducted at a tertiary hospital in Malaysia involving adults with MRSA bacteraemia treated from 2014 to 2024. AUC/MIC data were analysed for patients receiving intermittent vancomycin dosing. Multivariable logistic regression identified independent predictors of mortality.
RESULTS: Among 148 patients included, the in-hospital mortality rate was 32.4% (n=48/148). Four factors were independently associated with in-hospital mortality: organ failure (adjusted OR (aOR) 19.28, 95% CI 5.14 to 72.26), recent antibiotic exposure (aOR 5.24, 95% CI 1.90 to 14.51), hypoalbuminaemia <30 g/L (aOR 4.56, 95% CI 1.69 to 13.06) and cerebrovascular disease (aOR 4.24, 95% CI 1.15 to 15.60). Subgroup analysis of patients on intermittent dosing revealed six independent predictors of in-hospital mortality: cerebrovascular disease (aOR 26.9, 95% CI 2.76 to 261.98), hypoalbuminaemia <30 g/L (aOR 10.68, 95% CI 1.54 to 74.29), organ failure (aOR 48.15, 95% CI 4.27 to 542.81), polymicrobial bacteraemia (aOR 24.28, 95% CI 3.09 to 190.64), persistent bacteraemia (aOR 90.08, 95% CI 2.85 to 2845.83) and intensive care unit admission (aOR 0.09, 95% CI 0.01 to 0.91), the latter showing a protective effect. Only 22.2% (n=26/117) achieved the target AUC/MIC, which was not significantly linked to mortality reduction.
CONCLUSIONS: Vancomycin AUC/MIC attainment was suboptimal, and mortality was primarily influenced by host factors and disease severity. Early risk stratification and timely intervention are critical to improve outcomes and guide resource prioritisation, particularly in settings with limited access to AUC-guided dosing.