Is it too late to buy stock in the company that makes linezolid?
This group up in Detroit reviewed 320 patients with MRSA bacteremia and found that 52.5% experienced Vancomycin failure. Their conclusion states several significant OR for failure, but review of the between-group differences doesn’t show a lot of significant differences. Nursing homes, for example, were the only p < 0.05, and predicted vancomycin success with a p of 0.02.
What is more important than their clinical predictors, however, is their review of the bactericidal activity of vancomycin – and that higher MICs and higher troughs are needed to effectively treat patients. I’ve seen our pharmacists recognize this at my hospital as well – the 1g IV Vancomycin standard initial load is transitioning to a weight-based dose.
But, more importantly, what we’re probably really observing is the initial stages of the end of vancomycin’s utility for MRSA. And, I hate to see what happens when TMP/SMX stops working, too….