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Title: Antibiotic choice may not explain poorer outcomes in patients with Staphylococcus aureus bacteremia and high vancomycin minimum inhibitory concentrations.
Austin Authors: Holmes, Natasha E ;Turnidge, John D;Munckhof, Wendy J;Robinson, James O;Korman, Tony M;O'Sullivan, Matthew V N;Anderson, Tara L;Roberts, Sally A;Gao, Wei;Christiansen, Keryn J;Coombs, Geoffrey W;Johnson, Paul D R ;Howden, Benjamin P 
Affiliation: Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 1-Aug-2011
Publication information: The Journal of Infectious Diseases; 204(3): 340-7
Abstract: There are concerns about reduced efficacy of vancomycin in patients with Staphylococcus aureus bacteremia (SAB), especially when the minimum inhibitory concentration (MIC) nears the upper limit of the susceptible range.We examined the relationship between antibiotic treatment, 30-day mortality, and microbiologic parameters in a large Australasian cohort of patients with SAB.We assessed 532 patients with SAB from 8 hospitals. All patients with methicillin-resistant S. aureus (MRSA) bacteremia were treated with vancomycin, and patients with methicillin-susceptible S. aureus (MSSA) bacteremia received either flucloxacillin or vancomycin. Increasing vancomycin MIC was associated with increased mortality in vancomycin-treated patients. However, even in patients with MSSA bacteremia treated with flucloxacillin, mortality was also higher if the vancomycin Etest MIC of their isolate was >1.5 μg/mL, compared with those with lower MIC isolates (26.8% vs 12.2%; P < .001). After adjustment in a multivariate model, age, hospital-onset SAB and vancomycin MIC were independently associated with mortality, but methicillin resistance and antibiotic choice were not.We have confirmed an association between higher vancomycin MIC and increased mortality in patients with SAB, but surprisingly this relationship was not related to the antibiotic treatment received, suggesting that the use of vancomycin per se is not responsible for the poorer outcome.
Gov't Doc #: 21742831
DOI: 10.1093/infdis/jir270
Type: Journal Article
Subjects: Adult
Anti-Bacterial Agents.therapeutic use
Bacteremia.drug therapy.mortality
Microbial Sensitivity Tests
Middle Aged
Multivariate Analysis
Staphylococcal Infections.drug therapy.mortality
Staphylococcus aureus.drug effects
Treatment Outcome
Vancomycin.therapeutic use
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