Clinical, microbiologic, and genetic determinants of persistent methicillin-resistant Staphylococcus aureus bacteremia.

Abstract

Methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) often persists despite full susceptibility to vancomycin; therefore, associated factors were assessed. A retrospective cohort analysis of 222 patients with MRSAB treated with vancomycin was conducted; patients with persistent MRSAB (pMRSAB) were compared to those with nonpersistent bacteremia (NPB). Incidence of pMRSAB was 9%. More patients with vancomycin MIC = 2 mg/L had pMRSAB (16%) compared to patients with vancomycin MIC <2 mg/L (5%), P = 0.012. SCCmec type and Panton-Valentine leukocidin production were similar between patients with pMRSAB and NPB. There was no difference in vancomycin troughs, time to first dose, or area under the concentration-time curve/MIC between groups. More metastatic complications were observed in pMRSAB 63% versus NPB 32% (P = 0.005). Multivariate analysis found endocarditis (odds ratio [OR], 2.3; P = 0.021), complicated MRSAB (OR, 2.6; P = 0.009), vancomycin MIC = 2 (OR, 2.6; P = 0.009), and septic shock (OR 2.2 P = 0.031), which were independent predictors of pMRSAB.

• Authors: Elizabeth A Neuner, Ed Casabar, Richard Reichley, Peggy S McKinnon
• Journal: Diagnostic microbiology and infectious disease (Diagn Microbiol Infect Dis) Vol. 67 Issue 3 Pg. 228-33 (Jul 2010) ISSN: 1879-0070 [Electronic] United States
• PMID: 20542203 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Vancomycin

Topics

• Anti-Bacterial Agents (pharmacokinetics, pharmacology, therapeutic use)
• Bacteremia (drug therapy, microbiology, pathology)
• Cohort Studies
• Female
• Humans
• Incidence
• Male
• Methicillin-Resistant Staphylococcus aureus (isolation & purification)
• Microbial Sensitivity Tests
• Middle Aged
• Retrospective Studies
• Staphylococcal Infections (drug therapy, microbiology, pathology)
• Vancomycin (pharmacokinetics, pharmacology, therapeutic use)
• Vancomycin Resistance