Relationship between vancomycin tolerance and clinical outcomes in Staphylococcus aureus bacteraemia.

ABSTRACT:

Background

Previous data have demonstrated the clinical importance of vancomycin MIC values in Staphylococcus aureus bacteraemia (SAB); however, the impact of vancomycin tolerance (VT) is unknown.

Objectives

To compare the frequency of clinical failure between patients with VT and non-VT isolates in SAB.

Methods

This was a retrospective cohort study of patients with SAB, excluding treatment?<48?h or polymicrobial bacteraemia. The primary outcome was clinical failure (composite of 30?day mortality, non-resolving signs and symptoms, and 60?day recurrence). Vancomycin MIC and MBC were determined by broth microdilution. The association between VT (MBC/MIC??32) and clinical failure was evaluated by multivariable Poisson regression.

Results

Of the 225 patients, 26.7% had VT isolates. VT was associated with clinical failure (48.0% overall) in unadjusted analysis [68.3% (n?=?41/60) versus 40.6% (n?=?67/165); P?ConclusionsVT was associated with clinical failure in SAB, irrespective of methicillin susceptibility or definitive treatment. VT may decrease the effectiveness of cell-wall-active therapy or be a surrogate marker of some other pathogen-specific factor associated with poor outcomes. Future research should evaluate if bactericidal non-cell-wall-active agents improve outcomes in VT SAB.

SUBMITTER: Britt NS 

PROVIDER: S-EPMC6075607 | biostudies-literature | 2017 Feb

REPOSITORIES: biostudies-literature