“…study the relationship between teicoplanin maintenance dosing and clinical outcomes in adults with MRSA bacteraemia” Lee et all (2015).
Lee. C-H., Tsai, C-Y., Li, C-C., Chien, C-C. and Liu, J-W. (2015) Teicoplanin therapy for MRSA bacteraemia: a retrospective study emphasizing the importance of maintenance dosing in improving clinical outcomes. Journal of Antimicrobial Chemotherapy. 70(1), p.257-263.
Objectives: To study the relationship between teicoplanin maintenance dosing and clinical outcomes in adults with MRSA bacteraemia.
Methods: MRSA bacteraemic patients who received three teicoplanin loading doses (6 mg/kg/12 h) followed by maintenance doses of 6 mg/kg/24 h (Group 1) or 6 mg/kg/12 h (Group 2) were retrospectively analysed. Evaluated on day 7, an unfavourable early clinical response referred to the presence of septic shock, persistent fever, persistent leucocytosis and/or persistent bacteraemia. Assessed at completion of teicoplanin therapy, an unfavourable final clinical response referred to clinical treatment failure.
Results: Compared with those in Group 1 (n = 122), patients in Group 2 (n = 82) had significantly higher rates of favourable early clinical response (P = 0.040) and final clinical response (P < 0.001) and a lower bloodstream-infection-related mortality rate (P = 0.018). Based on estimated ORs for favourable final clinical response in multivariate analysis, endocarditis (P < 0.001; OR 0.109, 95% CI 0.032–0.368), pneumonia (P < 0.001; OR 0.172, 95% CI 0.069–0.433), ICU admission (P < 0.001; OR 0.132, 95% CI 0.054–0.325) and high Pittsburgh bacteraemia score (P = 0.042; OR 0.187, 95% CI 0.021–0.457) were each a risk factor for an unfavourable final clinical response. Higher teicoplanin maintenance dosing contributed to a favourable final clinical response (P < 0.001; OR 8.800, 95% CI 3.602–21.502). Significantly higher favourable final clinical response rates were also found in patients with endocarditis (P = 0.007) and pneumonia (P < 0.001) in Group 2 compared with their counterparts in Group 1.
Conclusions: These data highlight the importance of higher teicoplanin maintenance dosing, especially for severe infections due to MRSA.
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