Articles: vancomycin-administration-dosage.
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Management of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia remains a challenge. The emergence of MRSA strains with reduced vancomycin susceptibility complicates treatment. ⋯ Among patients with MRSA bacteremia treated with vancomycin, reduced vancomycin susceptibility and vancomycin tolerance were not associated with mortality after adjusting for patient factors. Patient factors including severity of illness and underlying co-morbidities were associated with the mortality.
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Int. J. Antimicrob. Agents · Dec 2010
Clearance of vancomycin during continuous infusion in Intensive Care Unit patients: correlation with measured and estimated creatinine clearance and serum cystatin C.
Vancomycin (VAN) dosing requires adjustment to renal function, which is often estimated using the Cockcroft-Gault formula; however, its precision is poor in Intensive Care Unit (ICU) patients. VAN clearance (CL(Van)) during continuous infusion was prospectively determined in 25 ICU patients [14 male, 11 female; age range 31-82 years; body mass index (BMI) 16.5-41.5 kg/m²; Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission 8-36; creatinine clearance 25-195 mL/min] and its correlation with measured creatinine clearance (CL(Crea)), estimated creatinine clearance using the Cockcroft-Gault formula (CL(CG)) and estimated glomerular filtration rate according to Hoek's formula based on serum cystatin C (GFR(Hoek)) was investigated. The correlation between CL(Van) and CL(Crea) was very good (r²=0.88), but it was rather poor with CL(CG) (r² = 0.37) and was acceptable with GFR(Hoek) (r² = 0.70). For VAN dose adjustments in ICU patients, determination of cystatin C may be an interesting and practical alternative to measured CL(Crea), whereas the Cockcroft-Gault formula should be used with caution.
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Eur. J. Clin. Microbiol. Infect. Dis. · Dec 2010
The importance of a judicious and early empiric choice of antimicrobial for methicillin-resistant Staphylococcus aureus bacteraemia.
The purpose of this investigation was to examine the impact of antimicrobial regimens administered for hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia on the all-cause, 14-day mortality. We retrospectively examined the characteristics of the most effective empiric antimicrobial therapy in 87 consecutive patients, hospitalised at a single institution between April 2003 and March 2008, who presented with clinically and microbiologically confirmed MRSA bacteraemia. The all-cause mortality was measured 14 days after the diagnosis was made. ⋯ Among subgroups treated with vancomycin, the lowest mortality (6%) was observed among patients treated (a) within 48 h after the collection of blood cultures and (b) with doses sufficient to keep the blood concentrations in the area under the 0-24 h curve >400 μg h/ml (≥2.0 g/day). The empiric administration of antimicrobials effective against MRSA bacteraemia within 48 h after the collection of blood cultures increased the 14-day survival. If vancomycin is chosen, ≥2.0 g/day should be administered, starting within 48 h.
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Clinical Trial
The use of calcium sulfate impregnated with vancomycin in the treatment of open fractures of long bones: a preliminary study.
The purpose of this study was to investigate the effect of calcium sulfate impregnated with vancomycin combined with internal fixation in the treatment of open fractures of long bones. Between October 2007 and January 2008, twenty-eight patients (24 men, 4 women) who sustained open fractures of long bones were enrolled. Mean patient age was 34.5 years (range, 19-57 years). ⋯ Bone union was observed in 23 patients, with a mean bone union time of 5.8 months (range, 4-9 months). All the calcium sulfate pellets had completely resorbed in an average of 1.4 months (range, 1-2 months). Our study showed that the combination of internal fixation and calcium sulfate impregnated with vancomycin could decrease the incidence of deep infection without impairment to the bone healing process in the treatment of open fractures of long bones.
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Critical care medicine · Jan 2010
Randomized Controlled Trial Comparative StudyEffect of vancomycin plus rifampicin in the treatment of nosocomial methicillin-resistant Staphylococcus aureus pneumonia.
To investigate whether adding rifampicin to vancomycin could cure more patients with nosocomial methicillin-resistant Staphylococcus aureus pneumonia compared with vancomycin-only. ⋯ Vancomycin plus rifampicin seems to be more effective than vancomycin alone in the treatment of nosocomial methicillin-resistant Staphylococcus aureus pneumonia.