scholarly journals Comparison of Vancomycin Treatment Failures for Methicillin-Resistant Staphylococcus aureus Bacteremia Stratified by Minimum Inhibitory Concentration

2019 ◽  
Vol 35 (5) ◽  
pp. 203-207 ◽  
Author(s):  
Mary Joyce B. Wingler ◽  
Darrell T. Childress ◽  
Ricardo A. Maldonado
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Retrospective Chart Review ◽  
High Rate ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Vancomycin Mics ◽  
Significant Difference ◽  
Alternative Agent ◽  
Vancomycin Treatment

Background: Optimal treatment of methicillin-resistant Staphylococcus aureus bacteremias (MRSABs) with vancomycin minimum inhibitory concentrations (MICs) high within the susceptible range is of concern due to the high rate of mortality and increased prevalence. Objective: The purpose of this study is to evaluate vancomycin treatment failures in patients with MRSAB stratified by vancomycin MIC. Methods: In this retrospective chart review, patients ≥19 years of age with MRSAB between July 2010 and December 2016 were included if they received intravenous vancomycin for ≥72 hours. Vancomycin treatment failures were compared between patients with vancomycin MICs of ≤1 mg/L and 2 mg/L. Vancomycin treatment failure was defined as microbiological failure at 7 days. Inpatient mortality, 30-day readmission, vancomycin-associated nephrotoxicity, and early bacteremia clearance at 48 to 96 hours were assessed as secondary endpoints. Results: Fifty-eight patients were included in the vancomycin MIC ≤1 mg/L group and 22 patients in the vancomycin MIC 2 mg/L group. No significant difference was found in vancomycin treatment failures at 7 days between groups (88% vs 91%, respectively; P = .850). At 96 hours, there was no significant difference in vancomycin treatment failures between groups (72% vs 90%, respectively; P = .127). No significant difference was found in mortality ( P > .99) or 30-day readmission ( P > .99). Conclusions: In this study, vancomycin treatment failures were not more prevalent in patients with vancomycin MIC of 2 mg/L at 7 days. Regardless of MIC, antibiotics should be switched to an alternative agent at 7 days for persistent bacteremia.

scholarly journals Microbiological and Genotypic Analysis of Methicillin-Resistant Staphylococcus aureus Bacteremia

2008 ◽  
Vol 52 (9) ◽  
pp. 3441-3443 ◽  
Author(s):  
Carlo McCalla ◽  
Davida S. Smyth ◽  
D. Ashley Robinson ◽  
Judith Steenbergen ◽  
Steven A. Luperchio ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Study ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Accessory Gene ◽  
Methicillin Resistant ◽  
Accessory Gene Regulator ◽  
Staphylococcus Aureus Bacteremia ◽  
Genotypic Analysis ◽  
Vancomycin Mics ◽  
Vancomycin Treatment

ABSTRACT In a recent landmark trial of bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) isolates, vancomycin MICs were ≥1 μg/ml for only 16% of the isolates, and accessory gene regulator (agr) function as measured by delta-hemolysin activity was absent or reduced in only 28.1% of the isolates. This clinical study did not capture a population of MRSA isolates predictive of vancomycin treatment failure.

scholarly journals 204. Clinical Outcomes with Ceftaroline Monotherapy versus Daptomycin-Ceftaroline Combination Therapy in the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S209-S210
Author(s):  
Gabriela Andonie ◽  
Elizabeth O Hand ◽  
Kelly R Reveles ◽  
Kristi A Traugott
Keyword(s):  
Staphylococcus Aureus ◽  
Combination Therapy ◽  
Clinical Outcomes ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Controlled Trial ◽  
Primary Source ◽  
Retrospective Chart Review ◽  
Combination Group ◽  
Methicillin Resistant ◽  
Significant Difference

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with poor outcomes and increased mortality. Daptomycin (DAP) and ceftaroline (CPT) in combination has been explored as a potential treatment option and showed improved outcomes compared to vancomycin/standard therapy. CPT monotherapy has been evaluated as salvage therapy for MRSA bacteremia but, to our knowledge, not as a comparator to DAP-CPT combination therapy. The purpose of this study is to compare the clinical outcomes of DAP and CPT combination therapy to CPT monotherapy in the setting of MRSA bacteremia. Methods A retrospective chart review of adult patients (≥ 18 years of age) admitted to University Health from January 2017 to December 2020 with a diagnosis of MRSA bacteremia was performed. Patients received either CPT monotherapy or DAP-CPT combination therapy for a minimum of 48 hours during their course of therapy. Results Thirty-two patients met inclusion criteria and were evaluated. Primary source of infection was pulmonary in the CPT monotherapy group (n=7/24; 29.2%) and osteomyelitis in the DAP-CPT combination group (n= 4/8; 50.0%). Median duration of bacteremia was 8 days and 9 days in the CPT monotherapy and DAP-CPT combination group, respectively. Microbiological cure was achieved in 95.8% (n=23/24) of patients in the CPT monotherapy and 100% (n=8/8) of patients in the DAP-CPT combination group. Bacteremia relapse (30 day, p=0.62; 60 day, p=0.63), readmission rates (30 day, p=0.62; 60 day, p=0.63), and mortality rates (30 day, p=0.70; 90 day, p=0.85) were similar in both groups. There was no statistically significant difference in safety parameters, including incidence of acute kidney injury (p=1.00) and creatine kinase elevations (p=1.00). Bone marrow suppression after at least 72 hours of therapy, including anemia, leukopenia, and thrombocytopenia, was also not statistically significant between groups. Conclusion This study was unable to find a statistically significant difference in clinical outcomes between patients receiving CPT monotherapy or DAP-CPT combination therapy. A large prospective, randomized controlled trial to assess CPT monotherapy and DAP-CPT combination therapy for the treatment of persistent MRSA bacteremia is warranted. Disclosures All Authors: No reported disclosures

scholarly journals Clinical and Microbiological Characteristics of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Bacteremia Caused by Community-Associated PVL-Negative Strain

2021 ◽  
Author(s):  
Yun Woo Lee ◽  
Seongman Bae ◽  
Eunmi Yang ◽  
Hyemin Chung ◽  
Eunsil Kim ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Venous Catheter ◽  
Mortality Rates ◽  
Tertiary Hospital ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Microbiological Characteristics ◽  
Vancomycin Mics ◽  
Hospital Acquired

Abstract Background ST72-SCCmecIV, a community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strain in Korea, originated in the community and has been spreading in the healthcare settings. Herein, we describe the clinical and microbiological characteristics of patients with hospital-acquired MRSA bacteremia (MRSAB) caused by community-associated strains. Methods We analyzed hospital-acquired MRSAB cases caused by ST72-SCCmecIV using a prospective cohort of patients with SAB at in a tertiary hospital in Korea from July 2008 to December 2018. We compared the clinical and microbiological characteristics of ST72-SCCmecIV with ST5-SCCmecII, a representative hospital-associated genotype strain. Results Of the 1782 S. aureus bacteremia (SAB) cases, 628 (35.2%) were hospital-acquired MRSAB. Of the 628 isolates, 431 (68.6%) were ST5-SCCmecII and 152 (24.2%) were ST72-SCCmecIV. Patients with ST72-SCCmecIV were younger than those with ST5-SCCmecII and less likely to have a history of recent surgery, antibiotic treatment, nasal MRSA colonization, and central venous catheter placement. Compared with ST5-SCCmecII, ST72-SCCmecIV isolates were more likely to have vancomycin MICs ≤ 1.0 mg/L (P < 0.001). Osteoarticular infection as site of infection [7.2% (11/152) vs. 1.4% (6/431)] was more common in patients with ST72-SCCmecIV. There were no significant differences in the rate of recurrence (≤ 90 days), persistent bacteremia (≥ 7 days), and 30- and 90-day mortality rates between the two groups. Conclusions Osteoarticular infections were more prevalent in ST72-SCCmecIV MRSAB. Mortality rates between the ST72-SCCmecIV and ST5-SCCmecII groups were not significantly different.

scholarly journals Vancomycin Treatment Failure in Children With Methicillin-Resistant Staphylococcus aureus Bacteremia

2019 ◽  
Vol 24 (4) ◽  
pp. 312-319 ◽  
Author(s):  
Rebecca B. Regen ◽  
Sarah S. Schuman ◽  
Rebecca F. Chhim ◽  
Sandra R. Arnold ◽  
Kelley R. Lee
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Failure ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Treatment Success ◽  
Area Under The Curve ◽  
Failure Criteria ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Persistent Bacteremia ◽  
Vancomycin Treatment

OBJECTIVES Limited data exist regarding clinical outcomes of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in children treated with vancomycin. Treatment success in adults correlates best with an area under the curve/minimum inhibitory concentration (AUC24/MIC) ratio ≥400. It is unknown if this relationship is useful in children. METHODS Charts of children who received vancomycin ≥5 days for MRSA bacteremia with a steady state trough were reviewed. AUC24/MIC ratios were estimated using 2 different vancomycin clearance equations. Vancomycin treatment failure was defined as persistent bacteremia ≥7 days, recurrent bacteremia within 30 days, or 30-day mortality. RESULTS There were 67 bacteremia episodes in 65 patients. Nine (13.4%) met failure criteria: persistent bacteremia (n = 6), recurrent bacteremia (n = 2), 30-day mortality (n = 1). There were no differences between patients receiving <60 mg/kg/day and ≥60 mg/kg/day of vancomycin in median trough (11.9 versus 12.3 mg/L, p = 0.1). Troughs did not correlate well with AUC24/MIC ratios (R2 = 0.32 and 0.22). Patients receiving ≥60 mg/kg/day had greater probability of achieving ratios ≥400. There were no significant differences in median dose (p = 0.8), trough (p = 0.24), or AUC24/MIC ratios (p = 0.07 and p = 0.6) between patients with treatment success and failure. CONCLUSIONS Treatment failure was lower than previously reported in children. AUC24/MIC ratios ≥400 were frequently achieved but were not associated with treatment success, dose, or troughs. Prospective studies using standard definitions of vancomycin treatment failure are needed to understand treatment failure in children with MRSA bacteremia.

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