Predictors of persistent methicillin-resistant Staphylococcus aureus bacteraemia in patients treated with vancomycin

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Objectives: The high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) coupled with an increase in vancomycin use have induced vancomycin tolerance in MRSA, adversely affecting the outcome of MRSA bacteraemia. This study aimed to identify predictors of persistent MRSA bacteraemia (PMRSAB) in patients treated with vancomycin. Methods: A retrospective, case-control study was performed at a university hospital in Korea from January 2006 to February 2009. Subjects included 96 patients who had MRSA bacteraemia and received vancomycin under therapeutic drug monitoring. We compared the clinical characteristics, management and outcomes of cases with PMRSAB (≥7 days, n=31) with controls with non-PMRSAB (≤3 days, n=32). Vancomycin MICs were determined by the Vitek 2 system. Results: Of 96 patients with MRSA bacteraemia, MRSA isolates from 21 patients (21.9%) showed a vancomycin MIC of 2 mg/L. Independent predictors of PMRSAB were: retention of implicated medical devices [odds ratio (OR), 10.35; 95% confidence interval (CI), 1.03-104.55]; MRSA infection of at least two sites (OR, 10.24; 95% CI, 1.72-61.01); and vancomycin MIC of 2 mg/L (OR, 6.34; 95% CI, 1.21-33.09). The frequency of side effects and mean trough serum vancomycin concentrations were not significantly different between the two groups. Sixteen patients with PMRSAB subsequently received teicoplanin±arbekacin, linezolid or quinupristin/dalfopristin, due to vancomycin failure or intolerance. Conclusions: To minimize the risk of PMRSAB, early removal of implicated devices and evaluation for metastatic infections should be encouraged. Alternative antibiotic therapy is warranted for infections due to isolates with elevated vancomycin MICs, as well as for the high rates of side effects.

Original languageEnglish
Article numberdkq050
Pages (from-to)1015-1018
Number of pages4
JournalJournal of Antimicrobial Chemotherapy
Volume65
Issue number5
DOIs
Publication statusPublished - 2010 Mar 3

Fingerprint

Vancomycin
Methicillin-Resistant Staphylococcus aureus
Bacteremia
Linezolid
Odds Ratio
Confidence Intervals
Infection
Device Removal
Drug Monitoring
Case Management
Korea
Complementary Therapies
Case-Control Studies

Keywords

  • Case-control study
  • Minimum inhibitory concentration
  • Risk factors

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases
  • Medicine(all)

Cite this

@article{cc3dd3f83e084421a8eaae62f4998503,
title = "Predictors of persistent methicillin-resistant Staphylococcus aureus bacteraemia in patients treated with vancomycin",
abstract = "Objectives: The high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) coupled with an increase in vancomycin use have induced vancomycin tolerance in MRSA, adversely affecting the outcome of MRSA bacteraemia. This study aimed to identify predictors of persistent MRSA bacteraemia (PMRSAB) in patients treated with vancomycin. Methods: A retrospective, case-control study was performed at a university hospital in Korea from January 2006 to February 2009. Subjects included 96 patients who had MRSA bacteraemia and received vancomycin under therapeutic drug monitoring. We compared the clinical characteristics, management and outcomes of cases with PMRSAB (≥7 days, n=31) with controls with non-PMRSAB (≤3 days, n=32). Vancomycin MICs were determined by the Vitek 2 system. Results: Of 96 patients with MRSA bacteraemia, MRSA isolates from 21 patients (21.9{\%}) showed a vancomycin MIC of 2 mg/L. Independent predictors of PMRSAB were: retention of implicated medical devices [odds ratio (OR), 10.35; 95{\%} confidence interval (CI), 1.03-104.55]; MRSA infection of at least two sites (OR, 10.24; 95{\%} CI, 1.72-61.01); and vancomycin MIC of 2 mg/L (OR, 6.34; 95{\%} CI, 1.21-33.09). The frequency of side effects and mean trough serum vancomycin concentrations were not significantly different between the two groups. Sixteen patients with PMRSAB subsequently received teicoplanin±arbekacin, linezolid or quinupristin/dalfopristin, due to vancomycin failure or intolerance. Conclusions: To minimize the risk of PMRSAB, early removal of implicated devices and evaluation for metastatic infections should be encouraged. Alternative antibiotic therapy is warranted for infections due to isolates with elevated vancomycin MICs, as well as for the high rates of side effects.",
keywords = "Case-control study, Minimum inhibitory concentration, Risk factors",
author = "Yoon, {Young Kyung} and Kim, {Jeong Yeon} and Park, {Dae Won} and Sohn, {Jang Wook} and Min, {Ja Kim}",
year = "2010",
month = "3",
day = "3",
doi = "10.1093/jac/dkq050",
language = "English",
volume = "65",
pages = "1015--1018",
journal = "Journal of Antimicrobial Chemotherapy",
issn = "0305-7453",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - Predictors of persistent methicillin-resistant Staphylococcus aureus bacteraemia in patients treated with vancomycin

AU - Yoon, Young Kyung

AU - Kim, Jeong Yeon

AU - Park, Dae Won

AU - Sohn, Jang Wook

AU - Min, Ja Kim

PY - 2010/3/3

Y1 - 2010/3/3

N2 - Objectives: The high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) coupled with an increase in vancomycin use have induced vancomycin tolerance in MRSA, adversely affecting the outcome of MRSA bacteraemia. This study aimed to identify predictors of persistent MRSA bacteraemia (PMRSAB) in patients treated with vancomycin. Methods: A retrospective, case-control study was performed at a university hospital in Korea from January 2006 to February 2009. Subjects included 96 patients who had MRSA bacteraemia and received vancomycin under therapeutic drug monitoring. We compared the clinical characteristics, management and outcomes of cases with PMRSAB (≥7 days, n=31) with controls with non-PMRSAB (≤3 days, n=32). Vancomycin MICs were determined by the Vitek 2 system. Results: Of 96 patients with MRSA bacteraemia, MRSA isolates from 21 patients (21.9%) showed a vancomycin MIC of 2 mg/L. Independent predictors of PMRSAB were: retention of implicated medical devices [odds ratio (OR), 10.35; 95% confidence interval (CI), 1.03-104.55]; MRSA infection of at least two sites (OR, 10.24; 95% CI, 1.72-61.01); and vancomycin MIC of 2 mg/L (OR, 6.34; 95% CI, 1.21-33.09). The frequency of side effects and mean trough serum vancomycin concentrations were not significantly different between the two groups. Sixteen patients with PMRSAB subsequently received teicoplanin±arbekacin, linezolid or quinupristin/dalfopristin, due to vancomycin failure or intolerance. Conclusions: To minimize the risk of PMRSAB, early removal of implicated devices and evaluation for metastatic infections should be encouraged. Alternative antibiotic therapy is warranted for infections due to isolates with elevated vancomycin MICs, as well as for the high rates of side effects.

AB - Objectives: The high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) coupled with an increase in vancomycin use have induced vancomycin tolerance in MRSA, adversely affecting the outcome of MRSA bacteraemia. This study aimed to identify predictors of persistent MRSA bacteraemia (PMRSAB) in patients treated with vancomycin. Methods: A retrospective, case-control study was performed at a university hospital in Korea from January 2006 to February 2009. Subjects included 96 patients who had MRSA bacteraemia and received vancomycin under therapeutic drug monitoring. We compared the clinical characteristics, management and outcomes of cases with PMRSAB (≥7 days, n=31) with controls with non-PMRSAB (≤3 days, n=32). Vancomycin MICs were determined by the Vitek 2 system. Results: Of 96 patients with MRSA bacteraemia, MRSA isolates from 21 patients (21.9%) showed a vancomycin MIC of 2 mg/L. Independent predictors of PMRSAB were: retention of implicated medical devices [odds ratio (OR), 10.35; 95% confidence interval (CI), 1.03-104.55]; MRSA infection of at least two sites (OR, 10.24; 95% CI, 1.72-61.01); and vancomycin MIC of 2 mg/L (OR, 6.34; 95% CI, 1.21-33.09). The frequency of side effects and mean trough serum vancomycin concentrations were not significantly different between the two groups. Sixteen patients with PMRSAB subsequently received teicoplanin±arbekacin, linezolid or quinupristin/dalfopristin, due to vancomycin failure or intolerance. Conclusions: To minimize the risk of PMRSAB, early removal of implicated devices and evaluation for metastatic infections should be encouraged. Alternative antibiotic therapy is warranted for infections due to isolates with elevated vancomycin MICs, as well as for the high rates of side effects.

KW - Case-control study

KW - Minimum inhibitory concentration

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=77953703747&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77953703747&partnerID=8YFLogxK

U2 - 10.1093/jac/dkq050

DO - 10.1093/jac/dkq050

M3 - Article

C2 - 20200036

AN - SCOPUS:77953703747

VL - 65

SP - 1015

EP - 1018

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

IS - 5

M1 - dkq050

ER -