Vancomycin and daptomycin minimum inhibitory concentrations as a predictor of outcome of methicillin-resistant Staphylococcus aureus bacteraemia

Autores de IIS La Fe

• Juan Ruiz Manzano

  Autor

• Paula Ramírez Galleymore

  Autor

• Miguel Salavert Lletí

  Autor

• Esther Villarreal Tello

  Autor

• Mónica Gordón Sahuquillo

  Autor

• Juan Salvador Frasquet Artes

  Autor

• Álvaro Castellanos Ortega

  Autor

Participantes ajenos a IIS La Fe

• Concha, P

Grupos

• Infección Grave

• Infecciones Respiratorias

• Medicina Intensiva

Abstract

Objectives: The aim of this study was to determine the persistence of the adverse prognostic effect of elevated vancomycin minimum inhibitory concentration (MIC) in methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in a setting with low vancomycin use. Methods: A retrospective study focusing on episodes of bacteraemia due to MRSA diagnosed from January 2010 through December 2015 was designed. The main outcome measures were 30-day mortality and treatment failure. Multivariate logistic regression analysis was used to identify variables associated with patient mortality and treatment outcome. Results: In total, 79 MRSA bacteraemia episodes were included. The vancomycin MIC was >1.0 mu g/mL in 53 episodes (67.1%). The presence of high vancomycin MIC was not associated with a higher mortality rate or treatment success. A daptomycin MIC >= 0.5 mu g/mL was present in 16 (26.2%) of 61 episodes for which the daptomycin MIC was obtained and was associated with 30-day mortality in the multivariate analysis (odds ratio = 4.72, 95% confidence interval 1.19-18.71). None of the antimicrobials used were associated with a lower risk of treatment failure or mortality. Conclusions: The pernicious effect of high vancomycin MIC disappears in the absence of a predominant use of this antibiotic. However, a high daptomycin MIC in MRSA bacteraemia is associated with higher mortality in patients with bacteraemia, irrespective of antimicrobial treatment choice. (C) 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

Keywords

• Staphylococcus aureus; Vancomycin; Daptomycin; Bacteraemia