MRSA sepsis in patients with hematological malignancies: Importance of early administration of intravenous vancomycin

From 1985 to 1991, MRSA sepsis was identified in 18 patients with hematological malignancies. The mortality rate was 55.6% (10/18), and the presence of DIC was significantly associated with high mortality (p=0.02). In addition to the use of standard empiric therapy, vancomycin was intravenously administered to 10 patients. The daily dose of 1.5 g was divided into 3 times, and was administered in 60-minute infusions. Patients 60 years of age or older received a daily dose of 1.0 g. The prognosis of 6 patients who received vancomycin within 4 days of the onset of sepsis was significantly better than that of 4 patients who received it 4 or more days after the onset of sepsis and that of 8 patients who did not receive it (mortality was 1/6 vs. 9/12; p=0.04). As for the side effects, liver dysfunction was observed in 5 patients and renal dysfunction was observed in 3 patients. The administration of VCM was discontinued in one of the former and was continued at a reduced dose in one of the latter. Because of the severity of the illness and the lack of effective drugs, we concluded that vancomycin is a highly useful drug for the treatment of MRSA sepsis in patients with hematological malignancies.