The impact of vancomycin susceptibility on treatment outcomes among patients with methicillin resistant <it>Staphylococcus aureus </it>bacteremia
<p>Abstract</p> <p>Background</p> <p>Management of methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) bacteremia remains a challenge. The emergence of MRSA strains with reduced vancomycin susceptibility complicates treatment.</p> <p>Meth...
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| Format: | Article |
| Language: | English |
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BMC
2011-12-01
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| Series: | BMC Infectious Diseases |
| Online Access: | http://www.biomedcentral.com/1471-2334/11/335 |
| _version_ | 1811280538276724736 |
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| author | Honda Hitoshi Doern Christopher D Michael-Dunne Wm Warren David K |
| author_facet | Honda Hitoshi Doern Christopher D Michael-Dunne Wm Warren David K |
| author_sort | Honda Hitoshi |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Management of methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) bacteremia remains a challenge. The emergence of MRSA strains with reduced vancomycin susceptibility complicates treatment.</p> <p>Methods</p> <p>A 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.</p> <p>Results</p> <p>One 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 <it>ug</it>/mL. Among strains with a vancomycin MIC ≥ 2 <it>ug</it>/mL, 10 isolates (8.9%) were vancomycin-intermediate <it>S. aureus </it>(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).</p> <p>Conclusions</p> <p>Among 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.</p> |
| first_indexed | 2024-04-13T01:16:36Z |
| format | Article |
| id | doaj.art-6d04af7ca24b44bb99465a76cdd460a5 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-13T01:16:36Z |
| publishDate | 2011-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-6d04af7ca24b44bb99465a76cdd460a52022-12-22T03:08:54ZengBMCBMC Infectious Diseases1471-23342011-12-0111133510.1186/1471-2334-11-335The impact of vancomycin susceptibility on treatment outcomes among patients with methicillin resistant <it>Staphylococcus aureus </it>bacteremiaHonda HitoshiDoern Christopher DMichael-Dunne WmWarren David K<p>Abstract</p> <p>Background</p> <p>Management of methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) bacteremia remains a challenge. The emergence of MRSA strains with reduced vancomycin susceptibility complicates treatment.</p> <p>Methods</p> <p>A 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.</p> <p>Results</p> <p>One 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 <it>ug</it>/mL. Among strains with a vancomycin MIC ≥ 2 <it>ug</it>/mL, 10 isolates (8.9%) were vancomycin-intermediate <it>S. aureus </it>(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).</p> <p>Conclusions</p> <p>Among 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.</p>http://www.biomedcentral.com/1471-2334/11/335 |
| spellingShingle | Honda Hitoshi Doern Christopher D Michael-Dunne Wm Warren David K The impact of vancomycin susceptibility on treatment outcomes among patients with methicillin resistant <it>Staphylococcus aureus </it>bacteremia BMC Infectious Diseases |
| title | The impact of vancomycin susceptibility on treatment outcomes among patients with methicillin resistant <it>Staphylococcus aureus </it>bacteremia |
| title_full | The impact of vancomycin susceptibility on treatment outcomes among patients with methicillin resistant <it>Staphylococcus aureus </it>bacteremia |
| title_fullStr | The impact of vancomycin susceptibility on treatment outcomes among patients with methicillin resistant <it>Staphylococcus aureus </it>bacteremia |
| title_full_unstemmed | The impact of vancomycin susceptibility on treatment outcomes among patients with methicillin resistant <it>Staphylococcus aureus </it>bacteremia |
| title_short | The impact of vancomycin susceptibility on treatment outcomes among patients with methicillin resistant <it>Staphylococcus aureus </it>bacteremia |
| title_sort | impact of vancomycin susceptibility on treatment outcomes among patients with methicillin resistant it staphylococcus aureus it bacteremia |
| url | http://www.biomedcentral.com/1471-2334/11/335 |
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