The impact of vancomycin susceptibility on treatment outcomes among patients with methicillin resistant Staphylococcus aureusbacteremiaReport as inadecuate




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BMC Infectious Diseases

, 11:335

Bacterial and fungal diseases

Abstract

BackgroundManagement of methicillin-resistant Staphylococcus aureus MRSA bacteremia remains a challenge. The emergence of MRSA strains with reduced vancomycin susceptibility complicates treatment.

MethodsA prospective cohort study 2005-2007 of patients with MRSA bacteremia treated with vancomycin was performed at an academic hospital. Vancomycin minimum inhibitory concentration MIC and minimum bactericidal concentration MBC were determined for stored MRSA isolates. Cox regression analysis was performed to predict 28-day all-cause mortality.

ResultsOne hundred sixty-three patients with MRSA bacteremia were evaluated. One hundred twelve patients 68.7% had bacteremia due to MRSA with a vancomycin MIC ≥ 2 ug-mL. Among strains with a vancomycin MIC ≥ 2 ug-mL, 10 isolates 8.9% were vancomycin-intermediate S. aureus VISA. Thirty-five patients 21.5% died within 28 days after the diagnosis of MRSA bacteremia. Higher vancomycin MIC was not associated with mortality in this cohort adjusted hazard ratio aHR, 1.57; 95% confidence interval CI, 0.73-3.37. Vancomycin tolerance was observed in 4.3% 7-162 of isolates and was not associated with mortality crude HR, 0.62; 95% CI, 0.08-4.50. Factors independently associated with mortality included higher age aHR, 1.03; 95% CI 1.00-1.05, cirrhosis aHR, 3.01; 95% CI, 1.24-7.30, and intensive care unit admission within 48 hours after the diagnosis of bacteremia aHR, 5.99; 95% CI, 2.86-12.58.

ConclusionsAmong patients with MRSA bacteremia treated with vancomycin, reduced vancomycin susceptibility and vancomycin tolerance were not associated with mortality after adjusting for patient factors. Patient factors including severity of illness and underlying co-morbidities were associated with the mortality.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2334-11-335 contains supplementary material, which is available to authorized users.

Hitoshi Honda, Christopher D Doern, Wm Michael-Dunne Jr and David K Warren contributed equally to this work.

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Author: Hitoshi Honda - Christopher D Doern - Wm Michael-DunneJr - David K Warren

Source: https://link.springer.com/







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