Teicoplanin therapy for MRSA bacteraemia: a retrospective study emphasizing the importance of maintenance dosing in improving clinical outcomes

C.-H. Lee, C.-Y. Tsai, C.-C. Li, C.-C. Chien, J.-W. Liu
2014 Journal of Antimicrobial Chemotherapy  
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
more » ... t bacteraemia. Assessed at completion of teicoplanin therapy, an unfavourable final clinical response referred to clinical treatment failure. Results: Compared with those in Group 1 (n¼ 122), patients in Group 2 (n¼ 82) had significantly higher rates of favourable early clinical response (P ¼ 0.040) and final clinical response (P, 0.001) and a lower bloodstreaminfection-related mortality rate (P ¼ 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 ¼ 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 ¼ 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.
doi:10.1093/jac/dku335 pmid:25190719 fatcat:onairqobgzdidbruc726vuzhfq