What To Do When the Vanc MIC is 2? - KASIC

What To Do When the Vanc MIC is 2?

A patient is on D4 of vancomycin for MRSA bacteremia 2nd to a drained skin abscess. Pt is afebrile and wbc wnl. Repeat blood cultures are no growth to date. The MRSA vancomycin MIC is 2 mg/L. Change vanco to dapto?

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Explanation: Doses needed to achieve an AUC/MIC of 400-600 when the MIC is 2 mg/L are likely unsafe, however MRSA vancomycin MIC of 2 mg/L is difficult to determine accurately in most microbiology laboratories, and its finding may represent normal technical variability. The 2020 vancomycin dosing guidelines recommend that alternatives to vancomycin be guided by clinical judgement when the MIC > 1 mg/L and highlight that limitations in MIC determination by automated susceptibility platforms be considered. The 2011 IDSA MRSA guidelines recommend that the patient’s clinical response be used to determine the continued use of vancomycin, independent of MIC when the vancomycin MIC is in the susceptible range (≤ 2 mg/L). When an MIC of 2 mg/L is identified, treat the patient, not the number. Inquire with your microbiology laboratory regarding your susceptibility testing methods.

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