• Meghan N Jeffres, Warren Isakow, Joshua A Doherty, Peggy S McKinnon, David J Ritchie, Scott T Micek, and Marin H Kollef.
• Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, USA.
• Chest. 2006 Oct 1;130(4):947-55.

ObjectiveThe goal of this investigation was to determine whether vancomycin pharmacokinetic indexes (eg, serum trough concentrations or area under the concentration curve [AUC] values) were associated with mortality for patients with health-care-associated pneumonia (HCAP) attributed to methicillin-resistant Staphylococcus aureus (MRSA).DesignA retrospective, single-center, observational cohort study.SettingBarnes-Jewish Hospital, a 1,200-bed urban teaching facility.PatientsAdult patients requiring hospitalization who were identified as having HCAP attributed to MRSA by BAL semi-quantitative cultures.InterventionsRetrospective data collection from automated hospital, microbiology, and pharmacy databases.Measurements And Main ResultsOne hundred two patients with MRSA HCAP were identified over a 6.5-year period. Thirty-two patients (31.4%) died during their hospitalization. The mean (+/- SD) vancomycin trough concentrations (13.6 +/- 5.9 vs 13.9 +/- 6.7 microg/mL, respectively; p = 0.866) and AUC values (351 +/- 143 vs 354 +/- 109 microg/h/mL, respectively; p = 0.941) did not differ between survivors and nonsurvivors. The stratification of the vancomycin trough concentrations and AUC values yielded no relationship with hospital mortality.ConclusionsWe found no evidence that greater vancomycin trough concentrations or AUC values correlated with hospital outcome. Based on these results, aggressive dosing strategies for vancomycin (eg, trough concentrations of > 15 microg/mL) may not offer any advantage over traditional dose targets (range, 5 to 15 microg/mL).

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