Is reduced vancomycin susceptibility a factor associated with poor prognosis in MSSA bacteraemia?

The known data about the influence of vancomycin MIC on Staphylococcus aureus bacteraemia are contradictory. Our objective was to study the possible impact of vancomycin MIC ≥1.5 mg/L on short- and medium-term mortality. A prospective cohort study was carried out from March 2008 to January 2011 on a...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2015-09, Vol.70 (9), p.2652-2660
Main Authors: López-Cortés, L E, Velasco, C, Retamar, P, del Toro, M D, Gálvez-Acebal, J, de Cueto, M, García-Luque, I, Caballero, F J, Pascual, A, Rodríguez-Baño, J
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antibiotics
Bacteremia - drug therapy
Bacteremia - microbiology
Bacteremia - mortality
Bacterial Proteins - genetics
Electrophoresis, Gel, Pulsed-Field
Female
Gram-positive bacteria
Hemolysin Proteins - genetics
Humans
Male
Medical prognosis
Microbial Sensitivity Tests
Middle Aged
Molecular Typing
Mortality
Prognosis
Prospective Studies
Spain
Staphylococcal Infections - drug therapy
Staphylococcal Infections - microbiology
Staphylococcal Infections - mortality
Staphylococcus aureus - classification
Staphylococcus aureus - drug effects
Staphylococcus aureus - genetics
Survival Analysis
Tertiary Care Centers
Trans-Activators - genetics
Treatment Failure
Vancomycin - therapeutic use
Vancomycin Resistance
Virulence Factors - analysis
Virulence Factors - genetics
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Summary:The known data about the influence of vancomycin MIC on Staphylococcus aureus bacteraemia are contradictory. Our objective was to study the possible impact of vancomycin MIC ≥1.5 mg/L on short- and medium-term mortality. A prospective cohort study was carried out from March 2008 to January 2011 on adult patients with MSSA bacteraemia admitted to a tertiary hospital located in Seville (Spain). We studied the relationship between vancomycin MIC, accessory gene regulator (agr) type and absence of δ-haemolysin and poor prognosis. All isolates were genotyped by PFGE. Multivariate analysis, including a propensity score for having a vancomycin MIC of ≥1.5 mg/L, was performed by Cox regression. One hundred and thirty-five episodes of bacteraemia due to MSSA were included in the analysis. Twenty-nine (21.5%) isolates had a vancomycin MIC of ≥1.5 mg/L by Etest. There were no differences in agr distribution or absence of δ-haemolysin between isolates with reduced vancomycin susceptibility (RVS) and those without. RVS was not more frequent in specific clones; RVS was not associated with higher 14 or 30 day crude mortality (relative risk = 0.44, 95% CI = 0.14-1.35; and relative risk = 1.01, 95% CI = 0.52-1.96) rates, and it did not show higher rates of complicated bacteraemia (14.2% versus 13.8%, P = 0.61). Cox regression analysis did not significantly modify the results for 14 day mortality (HR = 0.39, 95% CI = 0.11-1.34) or 30 day mortality (HR = 0.89, 95% CI = 0.39-2.04). Contrary to previously published data, we did not find a relationship between RVS and higher mortality in patients with MSSA bacteraemia and we did not find a link with higher complicated bacteraemia rates.
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkv133