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dc.contributor.authorTrinh, T.D.
dc.contributor.authorZasowski, E.J.
dc.contributor.authorClaeys, K.C.
dc.date.accessioned2019-06-05T18:28:16Z
dc.date.available2019-06-05T18:28:16Z
dc.date.issued2018
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85042921568&doi=10.1007%2fs40121-018-0187-0&partnerID=40&md5=3b46fb2c7215d68a80907a3e8d533574
dc.identifier.urihttp://hdl.handle.net/10713/9429
dc.description.abstractIntroduction: Vancomycin remains the standard of care for invasive methicillin-resistant Staphylococcus aureus (MRSA) infections. Treatment failures from heteroresistant vancomycin-intermediate subpopulations (hVISA) are challenging to detect. Minimum inhibitory concentrations (MIC) identified by modified population analysis profile (PAP) is an alternative testing method. The aim of this study was to evaluate the role of PAP MIC on vancomycin failures in two high inoculum infections: MRSA infective endocarditis and pneumonia. Methods: Retrospective, observational study at Detroit Medical Center from 2008 to 2016. Adults ≥ 18 years with ≥ 1 positive MRSA blood culture from IE or pneumonia source and received ≥ 48 h vancomycin were included. The primary outcome was composite failure: MRSA bacteremia ≥ 7 days or 30-day all-cause mortality. Results: A total of 191 patients were included; 47.6% IE and 52.4% pneumonia. About 19% were hVISA isolates, median vancomycin PAP MIC of 3 (2, 3). More than half (54.5%) experienced composite failure with a larger proportion of PAP MIC ≥ 4 mg/L in this group (25 vs. 15%, p = 0.086). Patients with IE experienced prolonged bacteremia whereas patients with pneumonia experienced higher 30-day mortality. On logistic regression analysis, age [adjusted odds ratio (aOR), 1.026; 95% confidence interval (CI), 1.005–1.047; p = 0.014] and APACHE II score (aOR 1.039; 95% CI, 1.004–1.076; p = 0.029) independently predicted composite failure. Conclusion: Vancomycin PAP MIC may be a more relevant predictor of patient outcomes in persistent bacteremic MRSA infections (e.g., IE). This susceptibility method is less applicable in other high inoculum infections with shorter bacteremia durations and higher mortality rates (e.g., pneumonia). Copyright 2018, The Author(s).en_US
dc.description.urihttps://dx.doi.org/10.1007/s40121-018-0187-0en_US
dc.language.isoen-USen_US
dc.publisherSpringer Healthcareen_US
dc.relation.ispartofInfectious Diseases and Therapy
dc.subjectClinical outcomesen_US
dc.subjecthVISAen_US
dc.subjectInfective endocarditisen_US
dc.subjectPneumoniaen_US
dc.titleRole of Vancomycin Minimum Inhibitory Concentrations by Modified Population Analysis Profile Method and Clinical Outcomes in High Inoculum Methicillin-Resistant Staphylococcus aureus Infectionsen_US
dc.typeArticleen_US
dc.identifier.doi10.1007/s40121-018-0187-0


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