Antibiotic choice may not explain poorer outcomes in patients with Staphylococcus aureus bacteremia and high Vancomycin minimum inhibitory concentrations

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dc.contributor.authorHolmes, N.
dc.contributor.authorTurnidge, J.
dc.contributor.authorMunckhof, W.
dc.contributor.authorRobinson, J.
dc.contributor.authorKorman, T.
dc.contributor.authorO'Sullivan, M.
dc.contributor.authorAnderson, T.
dc.contributor.authorRoberts, S.
dc.contributor.authorGao, W.
dc.contributor.authorChristiansen, K.
dc.contributor.authorCoombs, G.
dc.contributor.authorJohnson, P.
dc.contributor.authorHowden, B.
dc.date.issued2011
dc.description.abstractBackground. 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. Methods. We examined the relationship between antibiotic treatment, 30-day mortality, and microbiologic parameters in a large Australasian cohort of patients with SAB. Results. 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. Conclusions. 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.
dc.description.statementofresponsibilityNatasha E. Holmes, John D. Turnidge, Wendy J. Munckhof, James O. Robinson, Tony M. Korman, Matthew V. N. O'Sullivan, Tara L. Anderson, Sally A. Roberts, Wei Gao, Keryn J. Christiansen, Geoffrey W. Coombs, Paul D. R. Johnson and Benjamin P. Howden
dc.identifier.citationJournal of Infectious Diseases, 2011; 204(3):340-347
dc.identifier.doi10.1093/infdis/jir270
dc.identifier.issn1537-6613
dc.identifier.issn1537-6613
dc.identifier.orcidTurnidge, J. [0000-0003-4240-5578]
dc.identifier.urihttp://hdl.handle.net/2440/68969
dc.language.isoen
dc.publisherOxford University Press
dc.rights© The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
dc.source.urihttps://doi.org/10.1093/infdis/jir270
dc.subjectHumans
dc.subjectStaphylococcus aureus
dc.subjectBacteremia
dc.subjectStaphylococcal Infections
dc.subjectVancomycin
dc.subjectAnti-Bacterial Agents
dc.subjectTreatment Outcome
dc.subjectMicrobial Sensitivity Tests
dc.subjectMultivariate Analysis
dc.subjectAdult
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.titleAntibiotic choice may not explain poorer outcomes in patients with Staphylococcus aureus bacteremia and high Vancomycin minimum inhibitory concentrations
dc.typeJournal article
pubs.publication-statusPublished

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