{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T23:34:31Z","timestamp":1767137671928,"version":"build-2238731810"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2012,2,28]],"date-time":"2012-02-28T00:00:00Z","timestamp":1330387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2012,3]]},"abstract":"\n Study Objective<\/jats:title>\n To compare clinical outcomes and costs in patients treated with the new vancomycin guidelines recommending goal serum trough concentrations of 15\u201320\u00a0mg\/L versus patients treated with vancomycin doses targeting trough concentrations 5\u201320\u00a0mg\/L prior to the new guidelines.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Retrospective quasi\u2010experimental study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Urban level I trauma center.<\/jats:p>\n <\/jats:sec>\n \n Patients<\/jats:title>\n \n A total of 200 patients treated with vancomycin for at least 72\u00a0hours for confirmed, complicated methicillin\u2010resistant\n Staphylococcus aureus<\/jats:italic>\n (\n MRSA<\/jats:styled-content>\n ) bacteremia during one of two study phases relative to the implementation of the vancomycin dosing guidelines targeting serum trough concentrations of 15\u201320\u00a0mg\/L: 2005\u20132007 (preperiod phase) and 2008\u20132010 (postperiod phase). One hundred patients in each phase were matched in a 1:1 ratio according to diagnosis, any concomitant nephrotoxic agents (e.g., aminoglycosides, colistin, acyclovir), and age\u00a0\u00b1\u00a05\u00a0years.\n <\/jats:p>\n <\/jats:sec>\n \n Measurements and Main Results<\/jats:title>\n \n Patients in the preperiod had significantly lower success rates with vancomycin than those in the postperiod (45% vs 60%, p=0.034). Median length of stay (\n LOS<\/jats:styled-content>\n ) was not significantly higher in patients in the preperiod versus postperiod (15\u00a0days vs 13.5\u00a0days; p=0.28), and patients in the preperiod received a longer median duration of vancomycin versus those in the postperiod (13\u00a0days vs 8.5\u00a0days; p<0.001). No statistically significant difference was noted in total hospital costs for patients treated with vancomycin during the preperiod versus the postperiod ($32,754 vs $27,709, p=0.147). However, total drug and monitoring costs of vancomycin were significantly higher for patients in the postperiod. Initial vancomycin trough levels were significantly lower in patients in the preperiod versus postperiod (12.3\u00a0mg\/L vs 15.8\u00a0mg\/L, p=0.02). Patients in the preperiod had lower rates of nephrotoxicity than those in the postperiod, although this difference was not statistically significant (15% vs 18%; p=0.85). Median (interquartile range)\n LOS<\/jats:styled-content>\n was significantly longer in patients who developed nephrotoxicity compared with patients who did not develop nephrotoxicity (17\u00a0days [11.5\u201336.5\u00a0days] vs 14\u00a0days [9\u201324\u00a0days], p=0.017). Costs associated with measurement of serum creatinine concentrations and vancomycin trough levels as well as labor were significantly higher in patients who developed nephrotoxicity.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Higher vancomycin trough concentrations improved outcomes in patients with complicated\n MRSA<\/jats:styled-content>\n bacteremia. In addition, more aggressive dosing was shown to significantly decrease overall duration of vancomycin therapy, which may affect total hospital\n LOS<\/jats:styled-content>\n and cost. Patients who experienced nephrotoxicity had a significantly longer hospital\n LOS<\/jats:styled-content>\n . Additional studies evaluating optimal therapy for\n MRSA<\/jats:styled-content>\n bacteremia in a larger cohort of matched patients are warranted.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/j.1875-9114.2011.01017.x","type":"journal-article","created":{"date-parts":[[2012,9,5]],"date-time":"2012-09-05T03:54:53Z","timestamp":1346817293000},"page":"195-201","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":71,"title":["Effects of Targeting Higher Vancomycin Trough Levels on Clinical Outcomes and Costs in a Matched Patient Cohort"],"prefix":"10.1002","volume":"32","author":[{"given":"Ravina","family":"Kullar","sequence":"first","affiliation":[{"name":"Anti\u2010Infective Research Laboratory"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan L.","family":"Davis","sequence":"additional","affiliation":[{"name":"the Department of Pharmacy Practice"},{"name":"the Department of Pharmacy Services Henry Ford Hospital 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