Is There a Clinical Association of Vancomycin MIC Creep, agr Group II Locus, and Treatment Failure in MRSA Bacteremia?

Sanctis, Jorgelina T. de; Swami, Aditi; Sawarynski, Kara E.; Gerasymchuk, Ludmyla; Powell, K P; Robinson-Dunn, Barbara; Carpenter, Christopher; Sims, Matthew

doi:10.1097/pdm.0b013e318208fc47

Cited by 13 publications

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“…Several studies have examined the associations between the agr group and mortality, with conflicting results. Increased mortality was noted for agr non-group II (199) and group II (258) isolates, while no mortality difference between agr groups was noted in two studies (49,120). These discrepancies may be explained in part by the considerable geographical variation in the agr group distribution (37 to 92% for group I, 4 to 50% for group II, 0 to 34% for group III, and 0 to 5% for group IV) among S. aureus isolates obtained from colonized and infected individuals (120,251,258,264,304).…”

Section: Exotoxinsmentioning

confidence: 84%

Predictors of Mortality in Staphylococcus aureus Bacteremia

et al. 2012

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SUMMARY Staphylococcus aureus bacteremia (SAB) is an important infection with an incidence rate ranging from 20 to 50 cases/100,000 population per year. Between 10% and 30% of these patients will die from SAB. Comparatively, this accounts for a greater number of deaths than for AIDS, tuberculosis, and viral hepatitis combined. Multiple factors influence outcomes for SAB patients. The most consistent predictor of mortality is age, with older patients being twice as likely to die. Except for the presence of comorbidities, the impacts of other host factors, including gender, ethnicity, socioeconomic status, and immune status, are unclear. Pathogen-host interactions, especially the presence of shock and the source of SAB, are strong predictors of outcomes. Although antibiotic resistance may be associated with increased mortality, questions remain as to whether this reflects pathogen-specific factors or poorer responses to antibiotic therapy, namely, vancomycin. Optimal management relies on starting appropriate antibiotics in a timely fashion, resulting in improved outcomes for certain patient subgroups. The roles of surgery and infectious disease consultations require further study. Although the rate of mortality from SAB is declining, it remains high. Future international collaborative studies are required to tease out the relative contributions of various factors to mortality, which would enable the optimization of SAB management and patient outcomes.

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Section: Exotoxinsmentioning

confidence: 84%

Predictors of Mortality in Staphylococcus aureus Bacteremia

et al. 2012

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“…Considerable controversy exists concerning the relationship between vancomycin MICs and clinical outcomes. Several studies have reported association between higher vancomycin MIC and increased risk of treatment failure or mortality [ 30 , 47 – 54 ], with others finding no significant association with poor outcomes [ 37 , 55 – 59 ]. However, recent meta-analysis study in high vancomycin MIC and clinical outcomes in adults with MRSA infections by Jacob and DiazGranados [ 60 ] found that high vancomycin MIC was associated with increased mortality and treatment failure.…”

Section: Discussionmentioning

confidence: 99%

The safety and efficacy of high versus low vancomycin trough levels in the treatment of patients with infections caused by methicillin-resistant Staphylococcus aureus: a meta-analysis

Tongsai

Koomanachai

2016

BMC Res Notes

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BackgroundRecent guidelines have recommended vancomycin trough levels of 15–20 mg/L for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA). However, high trough levels may increase risk of nephrotoxicity and mortality, and high vancomycin trough levels have not been well studied. This study was designed to combine safety and efficacy results from independent studies and to compare between high and low vancomycin trough levels in the treatment of MRSA-infected patients using meta-analysis.MethodsFrom 19 eligible studies, 9 studies were included in meta-analysis to compare clinical success between high and low vancomycin trough levels, while 10 and 11 studies met criteria for comparing trough levels and nephrotoxicity and trough levels and mortality, respectively. The PubMed/Medline, Web of Science, and Scopus databases, and hand searching were used to identify eligible studies dated up to March 2016. Of 2344 subjects with MRSA infection, 1036 were assigned to trough levels ≥15 mg/L and 1308 to trough levels <15 mg/L.ResultsHigh vancomycin trough levels were found to be associated with risk of nephrotoxicity (odds ratio [OR] 2.14, 95 % confidence interval [CI] 1.42–3.23 and adjusted OR 3.33, 95 % CI 1.91–5.79). There was no evidence of difference between high and low vancomycin trough levels for mortality (OR; 1.09; 95 % CI 0.75–1.60) or clinical success (OR 1.07; 95 % CI 0.68–1.68).ConclusionIn this study, high vancomycin trough levels were identified as an independent factor associated with risk of nephrotoxicity in MRSA-infected patients. Association between vancomycin trough levels and both adverse effects and clinical outcomes requires further study.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2252-7) contains supplementary material, which is available to authorized users.

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“…A number of studies, including systematic reviews and meta-analyses, have demonstrated increased mortality in the setting of SAB with vancomycin MICs of Ն2.0 g/ml (21)(22)(23)(24)(25)(26)(27)(28). Conversely, others have shown an increased risk of mortality in individuals with MICs of Ͻ2.0 g/ml (29)(30)(31)(32). In spite of these data, the majority of studies have failed to show any significant increase in the risk of mortality attributable to vancomycin MIC (5,26,.…”

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confidence: 99%

Vancomycin MIC Does Not Predict 90-Day Mortality, Readmission, or Recurrence in a Prospective Cohort of Adults with Staphylococcus aureus Bacteremia

Baxi

Clemenzi-Allen

Gahbauer

et al. 2016

Antimicrob Agents Chemother

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Staphylococcus aureus is a leading cause of bacteremia (1, 2). Even when an individual is appropriately treated, the risk of mortality from S. aureus bacteremia (SAB) is 20 to 40% per episode (3-8). Furthermore, the morbidity from SAB is striking, with 10 to 15% of episodes being complicated by endocarditis or a risk of metastatic disease elsewhere in the body (9, 10). The financial consequences of SAB are also significant, with health care costs ranging from $12,078 to $25,573 per episode of SAB (11-13). Typically, SAB is treated with narrow-spectrum beta-lactam antibiotics for methicillin-susceptible S. aureus (MSSA) isolates and the glycopeptide antibiotic vancomycin for methicillin-resistant S. aureus (MRSA) isolates (14-17). Isolates with vancomycin MICs of Յ2 g/ml are considered susceptible, those with MICs of 4 to 8 g/ml are considered intermediately resistant, and those with MICs of Ͼ8 g/ml are designated resistant (18). The question of whether infection by S. aureus strains with vancomycin MICs of 2 g/ml is associated with worse outcomes has been a topic of much research, although a consensus has not been reached. Compared with research methods such as Epsilometer testing (Etest) or broth microdilution (BMD), automated MIC measurements can be off by 1 dilution in either direction (e.g., a value of 2 g/ml could mean 1 or 4 g/ml if repeated) (19,20), which adds to the deliberation over interpreting study results, although consistency between BMD and Etest results can also vary. In addition, most studies have focused on MRSA, but the role of vancomycin MIC in MSSA infection has not been fully evaluated. A number of studies, including systematic reviews and meta-analyses, have demonstrated increased mortality in the setting of SAB with vancomycin MICs of Ն2.0 g/ml (21-28). Conversely, others have shown an increased risk of mortality in individuals with MICs of Ͻ2.0 g/ml (29-32). In spite of these data, the majority of studies have failed to show any significant increase in the risk of mortality attributable to vancomycin MIC (5,26,. A recent rigorous meta-analysis failed to demonstrate increased 30-day or in-hospital mortality attributable to vancomycin MIC, irrespective of the MIC cutoff that was chosen (1.5, 2.0, 4.0, or 8.0 g/ml) (5). Although valuable, meta-analyses are lim-

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Is There a Clinical Association of Vancomycin MIC Creep, agr Group II Locus, and Treatment Failure in MRSA Bacteremia?

Abstract: We did not identify any significant association between MIC creep and vancomycin failure or between higher vancomycin MICs and agr group II. However, a higher mortality was seen in agr group II than agr group I.

Cited by 13 publications

References 0 publications

Predictors of Mortality in Staphylococcus aureus Bacteremia

Predictors of Mortality in Staphylococcus aureus Bacteremia

The safety and efficacy of high versus low vancomycin trough levels in the treatment of patients with infections caused by methicillin-resistant Staphylococcus aureus: a meta-analysis

Vancomycin MIC Does Not Predict 90-Day Mortality, Readmission, or Recurrence in a Prospective Cohort of Adults with Staphylococcus aureus Bacteremia

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