Methods: We conducted a national retrospective cohort study of obese patients (body mass index ≥ 30) admitted to Veterans Affairs hospitals between 2002 and 2012 with suspected pneumonia (positive MRSA respiratory cultures and clinical signs of infection). Patients were included if they were initiated on vancomycin treatment and had appropriately collected vancomycin trough levels and no evidence of acute kidney injury prior to vancomycin initiation. The effect of vancomycin target trough concentrations (15-20 mg/L) compared to non-target troughs (<15 or >20 mg/L) on time to hospital discharge, intensive care unit discharge, 30-day mortality, inpatient mortality, therapy discontinuation, therapy change, 30-day readmission, and 30-day MRSA reinfection was assessed through propensity matching and adjustment of Cox proportional hazards regression models
Results: We identified 301 patients treated with vancomycin with appropriately collected troughs. Of those, 21.9% (n=66) had a target trough concentration of 15-20 mg/L and 78.1% (n=235) had a non-target trough concentration. Patient characteristics were well balanced after implementing propensity score matching (36 matched pairs) and adjustment (within quintiles). In unadjusted analyses, target trough concentrations of 15-20 mg/L were associated with a lower mortality rate (HR 0.506, 95% CI 0.267- 0.960) than non-target troughs. However, in adjusted and matched analyses, no significant differences were observed for any of the outcomes assessed.
Conclusion: In our real-world study of obese patients with suspected MRSA pneumonia, clinical outcomes among those with target trough concentrations of 15-20 mg/L were similar to patients with non-target trough concentrations.
E. Noh, None
K. Laplante, Cubist Pharmaceuticals: Grant Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
Pfizer Pharmaceuticals: Grant Investigator , Grant recipient
Theravance Biopharma: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient
Durata: Scientific Advisor , Consulting fee
Forest Laboratories: Scientific Advisor , Consulting fee
Marvao: Grant Investigator , Grant recipient
Melinta: Scientific Advisor , Consulting fee
Davol: Scientific Advisor , Consulting fee
Theradoc: Scientific Advisor , Consulting fee
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