51-Efficacy of Vancomycin Loading Doses in Methicillin-Resistant Staphylococcus aureus Bacteremia
Back to course
Video Transcription
Video Summary
Asset Subtitle
Pharmacology, Infection, 2021
Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Nirali Kalaria


Introduction/Hypothesis: Vancomycin is routinely used to treat infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In critically ill patients, vancomycin loading doses are utilized to rapidly attain target serum concentrations. The vancomycin guidelines cite the use of loading doses as a level II, grade B recommendation due to a lack of robust evidence. Using higher initial doses has resulted in positive pharmacokinetic results, with more patients reaching goal trough levels sooner. However, the clinical implication of this pharmacokinetic response has not been extensively studied. The purpose of this study was to compare clinical outcomes in patients with MRSA bacteremia who did and did not receive a vancomycin loading dose.

Methods: This retrospective, single-center, cohort study included patients who received vancomycin for at least 72 hours for MRSA bacteremia from January 2014 to June 2019. The cutoff of 20 mg/kg of vancomycin was used to identify patients who received a loading dose. The primary objective was to compare composite clinical failure. This endpoint included day seven microbiological failure, switching of vancomycin to another anti-MRSA antibiotic prior to blood culture clearance, and in-hospital mortality prior to blood culture clearance. Statistical analysis was performed using the chi-square test for categorical data and the Wilcoxon signed rank test for continuous data.

Results: A total of 359 patients were included in the study, with 239 patients receiving a loading dose. The median initial vancomycin dose administered in the control group was 16.1 mg/kg compared to 26 mg/kg in the loading dose group (p<0.001). Baseline characteristics were similar between groups except a higher median baseline serum creatinine (1.94 mg/dL vs 0.92 mg/dL, p<0.001) and Elixhauser comorbidity score (25 vs 17, p=0.001) in the control group. There was no significant difference in the composite primary outcome (20.8% vs 19.2%, p=0.45) or its individual components. There was also no significant difference in secondary outcomes between the two groups: Day four microbiological failure (26.7% vs 25.9%), in-hospital mortality (12.5% vs 9.2%), and nephrotoxicity (11.1% vs 6.6%).

Conclusions: The utilization of a vancomycin loading dose did not alter clinical outcomes in patients with MRSA bacteremia.


Meta Tag
Content Type Presentation
Knowledge Area Pharmacology
Knowledge Area Infection
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Antibiotics
Year 2021
loading doses
methicillin-resistant Staphylococcus aureus bacteremia
clinical outcomes


Society of Critical Care Medicine

500 Midway Drive
Mount Prospect, IL 60056 USA

Phone: +1 847 827-6888
Fax: +1 847 439-7226
Email: support@sccm.org

Contact Us

About SCCM


Advertising & Sponsorship




Patients & Families

Surviving Sepsis Campaign

Critical Care Societies Collaborative

kisspng-facebook-social-media-computer-icons-linkedin-soci-gray-5ac493cf1c2975.7867418415228323351154  - KW Symphony    Gray twitter 3 icon - Free gray social icons    Gray linkedin 3 icon - Free gray site logo icons    Gray instagram icon - Free gray social icons    YouTube Icon Gray Box - HONOR VETERANS NOW


© Society of Critical Care Medicine. All rights reserved.   |    Privacy Statement    |    Terms & Conditions
The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.

Android App Download IOS App Download Powered By