Dataset Information

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

ACCESS DATA

Publications

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

Britt Nicholas S NS Patel Nimish N Shireman Theresa I TI El Atrouni Wissam I WI Horvat Rebecca T RT Steed Molly E ME

The Journal of antimicrobial chemotherapy 20161220 2

<h4>Background</h4>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.<h4>Objectives</h4>To compare the frequency of clinical failure between patients with VT and non-VT isolates in SAB.<h4>Methods</h4>This was a retrospective cohort study of patients with SAB, excluding treatment <48 h or polymicrobial bacteraemia. The primary outcome was clinical failure (compos ...[more]

PMID: 27999028

Similar Datasets

Project description:ObjectiveThe use of the vancomycin minimum inhibitory concentration (MIC) as a prognostic predictor in patients with methicillin-susceptible Staphylococcus aureus (MSSA) has been debated in the last decade. We performed a systematic review and meta-analysis to investigate whether an elevated vancomycin MIC is associated with a worse prognosis for patients with MSSA bacteraemia.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase and the Cochrane Library were searched from inception to December 2019.Eligibility criteriaRandomised controlled trials or observational studies were considered eligible if they provided clinical outcomes of patients with MSSA bacteraemia, stratified by vancomycin MIC.Data synthesisPrimary outcome was mortality. Secondary outcomes included septic thrombophlebitis, persistent bacteraemia and complicated bacteraemia. Pooled ORs and 95% CIs were calculated. Subgroup analyses included the susceptibility testing method.ResultsFifteen observational studies were included. Bacteraemia due to MSSA isolates with high vancomycin MICs was associated with higher mortality than isolates with low MICs (OR 1.44; 95% CI 1.12 to 1.84; I2=40.3%). Additionally, significantly greater septic thrombophlebitis (OR 3.16; 95% CI 1.11 to 9.00; I2=58.6%) and a trend towards more persistent bacteraemia (OR 1.79; 95% CI 0.97 to 3.31; I2=0%) were observed in patients with high vancomycin MICs than in patients with low MICs. Differences in complicated bacteraemia were not significant. Similar findings were obtained in subgroup analyses using Etest. However, significant differences in outcomes were not observed between the high and low vancomycin MICs detected using broth microdilution.ConclusionThe available data suggest an association between elevated vancomycin MICs detected using Etest and adverse clinical outcomes for patients with MSSA bacteraemia. Future studies should validate these findings and explore the potential mechanisms.Prospero registration numberCRD42018090547.

Dataset Information

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

Background

Objectives

Methods

Results

Publications

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

Similar Datasets

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