Journal article
Antibiotic choice may not explain poorer outcomes in patients with Staphylococcus aureus bacteremia and high vancomycin minimum inhibitory concentrations
Journal of Infectious Diseases, Vol.204(3), pp.340-347
2011
Abstract
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 μg/mL, compared with thosewith 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, butmethicillin 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.
Details
- Title
- Antibiotic choice may not explain poorer outcomes in patients with Staphylococcus aureus bacteremia and high vancomycin minimum inhibitory concentrations
- Authors/Creators
- N.E. Holmes (Author/Creator)J.D. Turnidge (Author/Creator)W.J. Munckhof (Author/Creator)J.O. Robinson (Author/Creator)T.M. Korman (Author/Creator)M.V.N. O'Sullivan (Author/Creator)T.L. Anderson (Author/Creator)S.A. Roberts (Author/Creator)W. Gao (Author/Creator)K.J. Christiansen (Author/Creator)G.W. Coombs (Author/Creator)P.D.R. Johnson (Author/Creator)B.P. Howden (Author/Creator)
- Publication Details
- Journal of Infectious Diseases, Vol.204(3), pp.340-347
- Publisher
- Oxford University Press
- Identifiers
- 991005540758207891
- Copyright
- © The Author 2011.
- Murdoch Affiliation
- Murdoch University
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.23 Antibiotics & Antimicrobials
- 1.23.173 MRSA and VRE
- Web Of Science research areas
- Immunology
- Infectious Diseases
- Microbiology
- ESI research areas
- Immunology