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High vancomycin minimum inhibitory concentration is a predictor of mortality in meticillin-resistant Staphylococcus aureus bacteraemia

Authors
 Yu Mi Wi ; June Myung Kim ; Kyong Ran Peck ; Jae-Hoon Song ; Doo Ryeon Chung ; Kwan Soo Ko ; Cheol-In Kang ; Young Eun Ha ; Eun-Jeong Joo 
Citation
 International Journal of Antimicrobial Agents, Vol.40(2) : 108~113, 2012 
Journal Title
 International Journal of Antimicrobial Agents 
ISSN
 0924-8579 
Issue Date
2012
Abstract
Failure of vancomycin in the treatment of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia has been reported despite full susceptibility of the organism to vancomycin. A retrospective observational cohort study including 137 patients with MRSA bacteraemia was performed at two centres in South Korea during 2009–2010. A total of 137 patients with MRSA bacteraemia receiving vancomycin therapy were enrolled during the study period. Isolates from 13 (9.5%) of the 137 patients had minimum inhibitory concentrations (MICs) ≥1 μg/mL. The 30-day cumulative survival was 53.8% for patients infected with isolates having a MIC ≥ 1 μg/mL and 79.8% for patients infected with isolates having a MIC < 1 μg/mL (log-rank test, P = 0.026). Vancomycin MIC ≥ 1 μg/mL [hazard ratio (HR) = 7.0, 95% confidence interval (CI) 2.2–22.1; P = 0.001], nosocomial acquisition of bacteraemia (HR = 5.4, 95% CI 1.4–20.1; P = 0.013), rapidly fatal underlying diseases (HR = 20.5, 95% CI 3.9–106.4; P < 0.001), presentation with septic shock (HR = 8.4, 95% CI 3.0–23.3; P < 0.001), presence of complicated infections (HR = 5.6, 95% CI 2.0–15.8; P = 0.001) and persistent MRSA bacteraemia for ≥3 days (HR = 4.2, 95% CI 1.4–12.7; P = 0.012) were independent predictors of 30-day mortality in patients with MRSA bacteraemia. In patients with high Pitt bacteraemia scores (Pitt score ≥2), the delay in initiation of vancomycin therapy was significantly different between non-survivors and survivors (2.4 days vs. 1.1 days; P = 0.012). Vancomycin MIC ≥ 1 μg/mL had a significant impact on mortality of patients with MRSA bacteraemia. These findings support early consideration of alternative anti-MRSA agents in patients with MRSA bacteraemia who have high vancomycin MICs as well as prompt initiation of anti-MRSA treatment in patients with MRSA bacteraemia, especially those with high Pitt scores.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/90433
DOI
10.1016/j.ijantimicag.2012.04.003
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
Yonsei Authors
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Link
 http://www.sciencedirect.com/science/article/pii/S0924857912001616
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