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

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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

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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.

Project description:Staphylococcus aureus bacteraemia is a serious infection associated with significant complications, including recurrence of bacteraemia, endocarditis and metastatic foci of infection. The management of these patients is often complex, involving appropriate source control, a thorough review and investigations to exclude metastatic foci and infective endocarditis. Additionally, a prolonged course of intravenous antibiotics is often required. As part of our quality improvement project, the following five aspects were evaluated in 56 patients with S. aureus bacteraemia at two District General Hospitals: 1) adequate and timely removal of the source of bacteraemia, 2) echocardiography to exclude endocarditis, 3) repeat blood culture to prove clearance of bacteraemia, 4) adequate duration and choice of antibiotics and 5) documentation of bacteraemia in the discharge summary. After an initial review revealed several areas for improvement, we instituted five Plan-Do-Study-Act learning cycles which involved: teaching microbiology trainees and junior doctors, improving clinical liaison and communication between the microbiology team and clinicians, as well as a clinical review of patients by the microbiology team where appropriate. The post-intervention review evaluated 24 patients with S. aureus bacteraemia between November 2012 and May 2013. The proportion of patients undergoing an echocardiogram improved from 49% to 88%. Another marked improvement was seen in the timely obtaining of clearance blood cultures, with 88% of patients having clearance blood cultures within the 2-4 day window, compared to 56% pre-intervention. 70% of patients with uncomplicated S. aureus bacteraemia received an appropriate antibiotic course post-intervention, compared with 59% pre-intervention. Documentation of the S. aureus bacteraemia in the discharge summary improved from 65% to 75%. The support of the entire microbiology team was pivotal in the successful outcome of the quality improvement project.

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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