Methods: We studied CIV in 3 pediatric patients with invasive MRSA infections presenting to Sanford Children's Hospital, Sioux Falls, SD between 1/1/14-7/1/15. Retrospective chart review was conducted to obtain demographic, clinical, laboratory, and pharmacokinetic data including duration of CIV and time to defervescence and clearance of bacteremia, as well as associated diagnoses (defined by ICD-9).
Results: All of the children were diagnosed with MRSA bacteremia and septic shock (100%) and had osteomyelitis (n=3); 2/3 had pneumonia/pulmonary emboli. The children were aged between 2 and 15 years. All required ICU admission, mechanical ventilation and vasopressor support. CIV was initiated after lack of clinical improvement on intermittent vancomycin therapy, drainage of infectious foci as well as acceptable vancomycin MIC values (<1). The patients failed to achieve target trough serum concentrations on intermittent vancomycin dosing, despite frequent dose adjustments. CIV was initiated after a median of 7 days (range 6-9 days) of intermittent vancomycin. Desired serum concentrations were achieved within 24-48 hours after CIV initiation in all patients. Only 33% (6/18) of trough serum concentrations were in the targeted range (15-20 mcg/mL) on intermittent vancomycin compared to 82% of random serum concentrations within the targeted range (15-25 mcg/mL) on CIV (p<0.0007). CIV was continued for 6-13 days. The median duration for defervescence was 3 days (1-4 days) and for clearance of bacteremia was 2 days (1-4 days) after CIV initiation. CIV was not associated with any adverse effects or mortalities.
Conclusion: This report provides evidence to support the use of vancomycin as a first line agent for invasive MRSA in children, with potential benefit of CIV in patients with vancomycin-susceptible MRSA isolates, unable to attain target serum concentrations on intermittent dosing.
A. Heiberger, None
V. Kanala, None
E. Rubin-Peck, None
C. Wagner, None