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      1596. Impact of Vancomycin Area Under Curve on Persistent Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infections (BSI)

      abstract
      , PharmD, BCPS 1 , , PharmD, BCPS 1 , , MPH 2 , , PharmD, MPH 3 , , PharmD, MPH 4 , , PharmD, BCPS-AQ ID 5 , , PharmD, BCPS, BCIDP 6 , , PharmD, MPH, PhD 2
      Open Forum Infectious Diseases
      Oxford University Press

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          Abstract

          Background

          Persistent Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) are associated with significant morbidity, mortality, and healthcare expenditures. Vancomycin (VAN) remains the treatment of choice for invasive MRSA BSI. Current guidelines for the treatment of MRSA BSI recommend a VAN AUC 24h/MIC ratio ≥400. The Detroit Medical Center (DMC) implemented an AUC guided dosing strategy. However, data on the association between AUC 24h and clinical outcomes in MRSA BSI are limited. We aimed to evaluate the association between VAN AUC 24h and persistent bacteremia (PB) among patients with BSI.

          Methods

          Multi-center, retrospective cohort study from January 2015 to November 2018. We included adult patients with MRSA bacteremia treated with VAN for which AUC 24h monitoring was performed. AUC was measured using 2-level guided dosing. The primary outcome was PB defined as continued positive cultures >72 hours after VAN initiation. Classification and Regression Tree (CART) analysis was performed to determine the AUC 24h breakpoint (BP) most predictive of PB in the cohort. Mann–Whitney and Fischer exact tests were used for univariate analysis. The independent association between AUC 24h, dichotomized at the CART-derived cut-point, was then examined through multivariable logistic regression analysis.

          Results

          Overall, 137 patients were included. The median age was 59 (18–85) years, 69.3% male, and 75.2% African American predominance. Most common sources of BSI were skin/soft tissue (39.4%), pneumonia (25.5%), and osteoarticular (16.8%). The median APACHE II score was 13 (8–20). Median time to microbiological clearance was 2.5 days (0.5–12). Patients with AUC 24h ≤ 406.25 were more likely to have PB compared with those with AUC 24h > 406.25 (59.4% and 35.2%, respectively; P = 0.002). After controlling for age, intensive care stay, and concomitant β-lactam therapy; AUC of ≤ 406.25 (aOR 2.767, 95% CI 1.212–6.318) and endocarditis (aOR 2.87, 95% CI 1.079–7.638) were independently associated with PB.

          Conclusion

          VAN AUC 24h BP of <406.25 was independently associated with PB in patients with MRSA BSI. Our findings underscore the importance of VAN dose optimization to achieve timely bacterial clearance in MRSA bacteremia.

          Disclosures

          All authors: No reported disclosures.

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          Author and article information

          Journal
          Open Forum Infect Dis
          Open Forum Infect Dis
          ofid
          Open Forum Infectious Diseases
          Oxford University Press (US )
          2328-8957
          October 2019
          23 October 2019
          23 October 2019
          : 6
          : Suppl 2 , IDWeek 2019 Abstracts
          : S582
          Affiliations
          [1 ] Wayne State University , Detroit, Michigan
          [2 ] Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University , Detroit, Michigan
          [3 ] Tuoro University California , Vallejo, California
          [4 ] University of California San Francisco , San Francisco, California
          [5 ] Detroit Medical Center , Detroit, Michigan
          [6 ] University of Michigan College of Pharmacy , Ann Arbor, Michigan
          Article
          ofz360.1460
          10.1093/ofid/ofz360.1460
          6809073
          4b52d559-48fd-4ed4-b426-7d979c187bfe
          © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

          This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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          Page count
          Pages: 1
          Categories
          Abstracts
          Poster Abstracts

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