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• W2017314927 abstract "To the EditorWe have read with great interest the article in a recent issue of CHEST (October 2006) by Jeffres et al,1Jeffres MN Isakow W Doherty JA et al.Predictors of mortality for methicillin-resistantStaphylococcus aureushealth-care-associated pneumonia: specific evaluation for vancomycin pharmacokinetic indexes.Chest. 2006; 130: 947-955Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar which suggested that aggressive dosing strategies for vancomycin (eg, trough concentrations > 15 mg/L) may not offer any advantage over traditional dosing targets (range, 5 to 15 mg/L) in patients with methicillin-resistant Staphylococcus aureus (MRSA) health-care-associated pneumonia. A lack of response to treatment with vancomycin in patients infected with MRSA, and in patients infected with vancomycin intermediate-resistant S aureus (VISA) and heterogeneous VISA (hVISA),3Appelbaum PC The emergence of vancomycin-intermediate and vancomycin-resistantStaphylococcus aureus.Clin Microbiol Infect. 2006; 12: 16-23Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar has been increasingly reported despite apparent in vitro susceptibility (minimum inhibitory concentration [MIC], 2 mg/L).2Hidayat LK Hsu DI Quist R et al.High dose vancomycin therapy for methicillin-resistantStaphylococcus aureusinfections: efficacy and toxicity.Arch Intern Med. 2006; 166: 2138-2144Crossref PubMed Scopus (785) Google Scholar3Appelbaum PC The emergence of vancomycin-intermediate and vancomycin-resistantStaphylococcus aureus.Clin Microbiol Infect. 2006; 12: 16-23Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar Moreover, MRSA isolates that show reduced susceptibility to vancomycin (MIC, 2 mg/L) are highly prevalent among strains that cause invasive infections.2Hidayat LK Hsu DI Quist R et al.High dose vancomycin therapy for methicillin-resistantStaphylococcus aureusinfections: efficacy and toxicity.Arch Intern Med. 2006; 166: 2138-2144Crossref PubMed Scopus (785) Google ScholarIn the study by Jeffres et al,1Jeffres MN Isakow W Doherty JA et al.Predictors of mortality for methicillin-resistantStaphylococcus aureushealth-care-associated pneumonia: specific evaluation for vancomycin pharmacokinetic indexes.Chest. 2006; 130: 947-955Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar the tested staphylococci exhibited a mean vancomycin zone diameter > 14 mm and would therefore be considered fully susceptible. Nevertheless, disk diffusion is not an acceptable method for testing of the vancomycin susceptibility of S aureus, specifically for the detection of VISA or hVISA.3Appelbaum PC The emergence of vancomycin-intermediate and vancomycin-resistantStaphylococcus aureus.Clin Microbiol Infect. 2006; 12: 16-23Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar4Brown DFJ Edwards DI Hawkey PM et al.Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistantStaphylococcus aureus.J Antimicrob Chemother. 2005; 56: 1000-1018Crossref PubMed Scopus (292) Google Scholar Thus, the authors may not have excluded the idea that a lack of response to treatment was not associated with a high vancomycin MIC for MRSA (2 mg/L) or VISA/hVISA.Unbound trough serum concentrations of vancomycin that are four to five times the MIC or 24-h area under the curve/MIC ratio of 400 were shown to be the pharmacodynamic parameters that best correlated with a successful clinical outcome.5Rybak MJ The pharmacokinetic and pharmacodynamic properties of vancomycin.Clin Infect Dis. 2006; 42: S35-S39Crossref PubMed Scopus (527) Google Scholar Considering that vancomycin is 50% protein-bound in serum and that lung concentrations will not exceed 20 to 30% of the serum concentrations,5Rybak MJ The pharmacokinetic and pharmacodynamic properties of vancomycin.Clin Infect Dis. 2006; 42: S35-S39Crossref PubMed Scopus (527) Google Scholar a trough serum concentration level of 15 to 25 mg/L may be adequate for the treatment of MRSA with a MIC at the breakpoint for susceptibility (2 mg/L), with a concentration of 30 to 40 mg/L being required for the treatment of VISA/hVISA pneumonia. Unfortunately, Jeffres et al1Jeffres MN Isakow W Doherty JA et al.Predictors of mortality for methicillin-resistantStaphylococcus aureushealth-care-associated pneumonia: specific evaluation for vancomycin pharmacokinetic indexes.Chest. 2006; 130: 947-955Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar did not consider the potential impact of variations in MRSA MICs on differences in outcome. Thus, it still seems appropriate to continue monitoring vancomycin serum levels in order to ensure effective therapeutic concentrations until the results of well-designed prospective clinical studies, including vancomycin MIC determinations, become available. To the EditorWe have read with great interest the article in a recent issue of CHEST (October 2006) by Jeffres et al,1Jeffres MN Isakow W Doherty JA et al.Predictors of mortality for methicillin-resistantStaphylococcus aureushealth-care-associated pneumonia: specific evaluation for vancomycin pharmacokinetic indexes.Chest. 2006; 130: 947-955Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar which suggested that aggressive dosing strategies for vancomycin (eg, trough concentrations > 15 mg/L) may not offer any advantage over traditional dosing targets (range, 5 to 15 mg/L) in patients with methicillin-resistant Staphylococcus aureus (MRSA) health-care-associated pneumonia. A lack of response to treatment with vancomycin in patients infected with MRSA, and in patients infected with vancomycin intermediate-resistant S aureus (VISA) and heterogeneous VISA (hVISA),3Appelbaum PC The emergence of vancomycin-intermediate and vancomycin-resistantStaphylococcus aureus.Clin Microbiol Infect. 2006; 12: 16-23Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar has been increasingly reported despite apparent in vitro susceptibility (minimum inhibitory concentration [MIC], 2 mg/L).2Hidayat LK Hsu DI Quist R et al.High dose vancomycin therapy for methicillin-resistantStaphylococcus aureusinfections: efficacy and toxicity.Arch Intern Med. 2006; 166: 2138-2144Crossref PubMed Scopus (785) Google Scholar3Appelbaum PC The emergence of vancomycin-intermediate and vancomycin-resistantStaphylococcus aureus.Clin Microbiol Infect. 2006; 12: 16-23Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar Moreover, MRSA isolates that show reduced susceptibility to vancomycin (MIC, 2 mg/L) are highly prevalent among strains that cause invasive infections.2Hidayat LK Hsu DI Quist R et al.High dose vancomycin therapy for methicillin-resistantStaphylococcus aureusinfections: efficacy and toxicity.Arch Intern Med. 2006; 166: 2138-2144Crossref PubMed Scopus (785) Google ScholarIn the study by Jeffres et al,1Jeffres MN Isakow W Doherty JA et al.Predictors of mortality for methicillin-resistantStaphylococcus aureushealth-care-associated pneumonia: specific evaluation for vancomycin pharmacokinetic indexes.Chest. 2006; 130: 947-955Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar the tested staphylococci exhibited a mean vancomycin zone diameter > 14 mm and would therefore be considered fully susceptible. Nevertheless, disk diffusion is not an acceptable method for testing of the vancomycin susceptibility of S aureus, specifically for the detection of VISA or hVISA.3Appelbaum PC The emergence of vancomycin-intermediate and vancomycin-resistantStaphylococcus aureus.Clin Microbiol Infect. 2006; 12: 16-23Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar4Brown DFJ Edwards DI Hawkey PM et al.Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistantStaphylococcus aureus.J Antimicrob Chemother. 2005; 56: 1000-1018Crossref PubMed Scopus (292) Google Scholar Thus, the authors may not have excluded the idea that a lack of response to treatment was not associated with a high vancomycin MIC for MRSA (2 mg/L) or VISA/hVISA.Unbound trough serum concentrations of vancomycin that are four to five times the MIC or 24-h area under the curve/MIC ratio of 400 were shown to be the pharmacodynamic parameters that best correlated with a successful clinical outcome.5Rybak MJ The pharmacokinetic and pharmacodynamic properties of vancomycin.Clin Infect Dis. 2006; 42: S35-S39Crossref PubMed Scopus (527) Google Scholar Considering that vancomycin is 50% protein-bound in serum and that lung concentrations will not exceed 20 to 30% of the serum concentrations,5Rybak MJ The pharmacokinetic and pharmacodynamic properties of vancomycin.Clin Infect Dis. 2006; 42: S35-S39Crossref PubMed Scopus (527) Google Scholar a trough serum concentration level of 15 to 25 mg/L may be adequate for the treatment of MRSA with a MIC at the breakpoint for susceptibility (2 mg/L), with a concentration of 30 to 40 mg/L being required for the treatment of VISA/hVISA pneumonia. Unfortunately, Jeffres et al1Jeffres MN Isakow W Doherty JA et al.Predictors of mortality for methicillin-resistantStaphylococcus aureushealth-care-associated pneumonia: specific evaluation for vancomycin pharmacokinetic indexes.Chest. 2006; 130: 947-955Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar did not consider the potential impact of variations in MRSA MICs on differences in outcome. Thus, it still seems appropriate to continue monitoring vancomycin serum levels in order to ensure effective therapeutic concentrations until the results of well-designed prospective clinical studies, including vancomycin MIC determinations, become available. We have read with great interest the article in a recent issue of CHEST (October 2006) by Jeffres et al,1Jeffres MN Isakow W Doherty JA et al.Predictors of mortality for methicillin-resistantStaphylococcus aureushealth-care-associated pneumonia: specific evaluation for vancomycin pharmacokinetic indexes.Chest. 2006; 130: 947-955Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar which suggested that aggressive dosing strategies for vancomycin (eg, trough concentrations > 15 mg/L) may not offer any advantage over traditional dosing targets (range, 5 to 15 mg/L) in patients with methicillin-resistant Staphylococcus aureus (MRSA) health-care-associated pneumonia. A lack of response to treatment with vancomycin in patients infected with MRSA, and in patients infected with vancomycin intermediate-resistant S aureus (VISA) and heterogeneous VISA (hVISA),3Appelbaum PC The emergence of vancomycin-intermediate and vancomycin-resistantStaphylococcus aureus.Clin Microbiol Infect. 2006; 12: 16-23Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar has been increasingly reported despite apparent in vitro susceptibility (minimum inhibitory concentration [MIC], 2 mg/L).2Hidayat LK Hsu DI Quist R et al.High dose vancomycin therapy for methicillin-resistantStaphylococcus aureusinfections: efficacy and toxicity.Arch Intern Med. 2006; 166: 2138-2144Crossref PubMed Scopus (785) Google Scholar3Appelbaum PC The emergence of vancomycin-intermediate and vancomycin-resistantStaphylococcus aureus.Clin Microbiol Infect. 2006; 12: 16-23Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar Moreover, MRSA isolates that show reduced susceptibility to vancomycin (MIC, 2 mg/L) are highly prevalent among strains that cause invasive infections.2Hidayat LK Hsu DI Quist R et al.High dose vancomycin therapy for methicillin-resistantStaphylococcus aureusinfections: efficacy and toxicity.Arch Intern Med. 2006; 166: 2138-2144Crossref PubMed Scopus (785) Google Scholar In the study by Jeffres et al,1Jeffres MN Isakow W Doherty JA et al.Predictors of mortality for methicillin-resistantStaphylococcus aureushealth-care-associated pneumonia: specific evaluation for vancomycin pharmacokinetic indexes.Chest. 2006; 130: 947-955Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar the tested staphylococci exhibited a mean vancomycin zone diameter > 14 mm and would therefore be considered fully susceptible. Nevertheless, disk diffusion is not an acceptable method for testing of the vancomycin susceptibility of S aureus, specifically for the detection of VISA or hVISA.3Appelbaum PC The emergence of vancomycin-intermediate and vancomycin-resistantStaphylococcus aureus.Clin Microbiol Infect. 2006; 12: 16-23Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar4Brown DFJ Edwards DI Hawkey PM et al.Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistantStaphylococcus aureus.J Antimicrob Chemother. 2005; 56: 1000-1018Crossref PubMed Scopus (292) Google Scholar Thus, the authors may not have excluded the idea that a lack of response to treatment was not associated with a high vancomycin MIC for MRSA (2 mg/L) or VISA/hVISA. Unbound trough serum concentrations of vancomycin that are four to five times the MIC or 24-h area under the curve/MIC ratio of 400 were shown to be the pharmacodynamic parameters that best correlated with a successful clinical outcome.5Rybak MJ The pharmacokinetic and pharmacodynamic properties of vancomycin.Clin Infect Dis. 2006; 42: S35-S39Crossref PubMed Scopus (527) Google Scholar Considering that vancomycin is 50% protein-bound in serum and that lung concentrations will not exceed 20 to 30% of the serum concentrations,5Rybak MJ The pharmacokinetic and pharmacodynamic properties of vancomycin.Clin Infect Dis. 2006; 42: S35-S39Crossref PubMed Scopus (527) Google Scholar a trough serum concentration level of 15 to 25 mg/L may be adequate for the treatment of MRSA with a MIC at the breakpoint for susceptibility (2 mg/L), with a concentration of 30 to 40 mg/L being required for the treatment of VISA/hVISA pneumonia. Unfortunately, Jeffres et al1Jeffres MN Isakow W Doherty JA et al.Predictors of mortality for methicillin-resistantStaphylococcus aureushealth-care-associated pneumonia: specific evaluation for vancomycin pharmacokinetic indexes.Chest. 2006; 130: 947-955Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar did not consider the potential impact of variations in MRSA MICs on differences in outcome. Thus, it still seems appropriate to continue monitoring vancomycin serum levels in order to ensure effective therapeutic concentrations until the results of well-designed prospective clinical studies, including vancomycin MIC determinations, become available." @default.
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• W2017314927 title "Methicillin-Resistant Staphylococcus aureus Pneumonia Treatment" @default.
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