Clinical characteristics of vancomycin minimum inhibitory concentration of 2 μg/ml methicillin-resistant Staphylococcus aureus strains isolated from patients with bacteremia

被引:50
作者
Takesue, Yoshio [1 ]
Nakajima, Kazuhiko [1 ]
Takahashi, Yoshiko [1 ]
Ichiki, Kaori [1 ]
Ishihara, Mika [2 ]
Wada, Yasunao [1 ]
Tsuchida, Toshie [1 ]
Uchino, Motoi [3 ]
Ikeuchi, Hiroki [3 ]
机构
[1] Hyogo Coll Med, Dept Infect Control & Prevent, Nishinomiya, Hyogo 6638501, Japan
[2] Hyogo Coll Med, Dept Pharm, Nishinomiya, Hyogo 6638501, Japan
[3] Hyogo Coll Med, Dept Surg, Nishinomiya, Hyogo 6638501, Japan
关键词
Vancomycin; Methicillin-resistant Staphylococcus aureus; Bacteremia; BACTERICIDAL ACTIVITY; INFECTIONS; EFFICACY; CREEP;
D O I
10.1007/s10156-010-0086-0
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Recent studies demonstrated that mortality associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was high when vancomycin was used to treat infections with strains that had a high vancomycin minimum inhibitory concentration (MIC). This study compared several characteristics of vancomycin MIC 2 mu g/ml strains isolated from bacteremia with those isolated from infections other than bacteremia. A total of 128 episodes of MRSA bacteremia between 2005 and 2008 were followed-up, and compared with 631 MRSA infections other than bacteremia. The isolation of strains with a 2 mu g/ml MIC accounted for 32.0% of isolates from MRSA bacteremia, whereas strains with a 2 mu g/ml MIC comprised 9.0% of MRSA isolated from other sites (p < 0.001). The incidence of pneumonia as the source of infection was significantly higher in patients with bacteremia from strains with a 2 mu g/ml MIC than in those with a parts per thousand currency sign1 mu g/ml MIC. Prior vancomycin use did not correlate with the isolation of 2 mu g/ml strains. The efficacy of glycopeptides as 1st line therapy in patients infected with 2 mu g/ml strains was significantly lower than that for patients infected with a parts per thousand currency sign1 mu g/ml strains (30.0 vs. 78.8%, p < 0.001) in bacteremia. In the analysis of infections other than bacteremia, efficacy did not reveal a significant difference according to MIC (69.0 vs. 79.6%, p = 0.109). In bacteremia, mortality was 65.8% in patients with 2 mu g/ml strains and 19.5% in patients with a parts per thousand currency sign1 mu g/ml strains (p < 0.001), whereas there was no significant difference in mortality from infections other than bacteremia (10.7 vs. 7.8%, p = 0.617). In multivariate analysis, bacteremia with 2 mu g/ml strains, intensive care unit (ICU) stay, and liver cirrhosis were independent risk factors for death in patients with bacteremia, and initial appropriate therapy lowered the risk. Several characteristics such as a higher incidence than at other infection sites, a high incidence of pneumonia as a source of infection, a low success rate of vancomycin therapy, and poor prognosis were confirmed in 2 mu g/ml MIC MRSA isolated from bacteremia; however, a low success rate of vancomycin and poor prognosis were not apparent in 2 mu g/ml MIC MRSA strains isolated from infections other than bacteremia.
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收藏
页码:52 / 57
页数:6
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