Predictors of mortality for methicillin-resistant Staphylococcus aureus health-care-associated pneumonia: specific evaluation of vancomycin pharmacokinetic indices

Chest. 2006 Oct;130(4):947-55. doi: 10.1378/chest.130.4.947.


Objective: The goal of this investigation was to determine whether vancomycin pharmacokinetic indexes (eg, serum trough concentrations or area under the concentration curve [AUC] values) were associated with mortality for patients with health-care-associated pneumonia (HCAP) attributed to methicillin-resistant Staphylococcus aureus (MRSA).

Design: A retrospective, single-center, observational cohort study.

Setting: Barnes-Jewish Hospital, a 1,200-bed urban teaching facility.

Patients: Adult patients requiring hospitalization who were identified as having HCAP attributed to MRSA by BAL semi-quantitative cultures.

Interventions: Retrospective data collection from automated hospital, microbiology, and pharmacy databases.

Measurements and main results: One hundred two patients with MRSA HCAP were identified over a 6.5-year period. Thirty-two patients (31.4%) died during their hospitalization. The mean (+/- SD) vancomycin trough concentrations (13.6 +/- 5.9 vs 13.9 +/- 6.7 microg/mL, respectively; p = 0.866) and AUC values (351 +/- 143 vs 354 +/- 109 microg/h/mL, respectively; p = 0.941) did not differ between survivors and nonsurvivors. The stratification of the vancomycin trough concentrations and AUC values yielded no relationship with hospital mortality.

Conclusions: We found no evidence that greater vancomycin trough concentrations or AUC values correlated with hospital outcome. Based on these results, aggressive dosing strategies for vancomycin (eg, trough concentrations of > 15 microg/mL) may not offer any advantage over traditional dose targets (range, 5 to 15 microg/mL).

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / pharmacokinetics*
  • Area Under Curve
  • Biological Availability
  • Cohort Studies
  • Cross Infection / blood
  • Cross Infection / drug therapy*
  • Cross Infection / mortality*
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Methicillin Resistance*
  • Middle Aged
  • Missouri
  • Pneumonia, Staphylococcal / blood
  • Pneumonia, Staphylococcal / drug therapy*
  • Pneumonia, Staphylococcal / mortality*
  • Retrospective Studies
  • Risk Factors
  • Staphylococcus aureus / drug effects*
  • Survival Analysis
  • Treatment Outcome
  • Vancomycin / administration & dosage*
  • Vancomycin / pharmacokinetics*


  • Anti-Bacterial Agents
  • Vancomycin