Antibiotic Choice May Not Explain Poorer Outcomes in Patients With Staphylococcus aureus Bacteremia and High Vancomycin Minimum Inhibitory Concentrations

被引：186

作者：

Holmes, Natasha E. ^{[1
]}

Turnidge, John D. ^{[2
,3
]}

Munckhof, Wendy J. ^{[4
,5
]}

Robinson, James O. ^{[6
]}

Korman, Tony M. ^{[7
,8
]}

O'Sullivan, Matthew V. N. ^{[9
]}

Anderson, Tara L. ^{[10
,11
]}

Roberts, Sally A. ^{[2
]}

Gao, Wei ^{[12
]}

Christiansen, Keryn J. ^{[13
,14
]}

Coombs, Geoffrey W. ^{[13
]}

Johnson, Paul D. R. ^{[1
,15
,16
]}

Howden, Benjamin P. ^{[1
,12
,15
,17
]}

机构：

[1] Austin Hlth, Dept Infect Dis, Heidelberg, Vic 3084, Australia

[2] Womens & Childrens Hosp, Div Lab Med, Adelaide, SA, Australia

[3] Univ Adelaide, Dept Pediat & Pathol, Woolloongabba, Qld, Australia

[4] Princess Alexandra Hosp, Dept Infect Dis, Woolloongabba, Qld 4102, Australia

[5] Univ Queensland, Dept Med, St Lucia, Qld 4067, Australia

[6] Royal Perth Hosp, Dept Infect Dis, Perth, WA, Australia

[7] Monash Univ, Dept Med, Clayton, Vic, Australia

[8] So Hlth, Dept Infect Dis, Clayton, Vic, Australia

[9] Westmead Hosp, Dept Infect Dis, Hobart, Tas, Australia

[10] Royal Hobart Hosp, Dept Infect Dis, Hobart, Tas, Australia

[11] Univ Tasmania, Dept Med, Hobart, Tas, Australia

[12] Austin Hlth, Dept Microbiol, Heidelberg, Vic, Australia

[13] Royal Perth Hosp, Dept Microbiol & Infect Dis, Perth, WA, Australia

[14] Univ Western Australia, Sch Biomed Biomol & Chem Sci, Perth, WA 6009, Australia

[15] Monash Univ, Dept Microbiol, Parkville, Vic, Australia

[16] Univ Melbourne, Dept Med, Parkville, Vic 3052, Australia

[17] Univ Melbourne, Dept Microbiol & Immunol, Parkville, Vic 3052, Australia

来源：

JOURNAL OF INFECTIOUS DISEASES | 2011年 / 204卷 / 03期

关键词：

METHICILLIN-RESISTANT; MORTALITY; IMPACT; ENDOCARDITIS; INFECTIONS; RECURRENCE; EFFICACY; THERAPY; FAILURE; VALUES;

D O I：

10.1093/infdis/jir270

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. There are concerns about reduced efficacy of vancomycin in patients with Staphylococcus aureus bacteremia (SAB), especially when the minimum inhibitory concentration (MIC) nears the upper limit of the susceptible range. Methods. We examined the relationship between antibiotic treatment, 30-day mortality, and microbiologic parameters in a large Australasian cohort of patients with SAB. Results. We assessed 532 patients with SAB from 8 hospitals. All patients with methicillin-resistant S. aureus (MRSA) bacteremia were treated with vancomycin, and patients with methicillin-susceptible S. aureus (MSSA) bacteremia received either flucloxacillin or vancomycin. Increasing vancomycin MIC was associated with increased mortality in vancomycin-treated patients. However, even in patients with MSSA bacteremia treated with flucloxacillin, mortality was also higher if the vancomycin Etest MIC of their isolate was >1.5 mu g/mL, compared with those with lower MIC isolates (26.8% vs 12.2%; P < .001). After adjustment in a multivariate model, age, hospital-onset SAB and vancomycin MIC were independently associated with mortality, but methicillin resistance and antibiotic choice were not. Conclusions. We have confirmed an association between higher vancomycin MIC and increased mortality in patients with SAB, but surprisingly this relationship was not related to the antibiotic treatment received, suggesting that the use of vancomycin per se is not responsible for the poorer outcome.

引用

页码：340 / 347

页数：8