Multicenter Prospective Observational Study of the Comparative Efficacy and Safety of Vancomycin versus Teicoplanin in Patients with Health Care-Associated Methicillin-Resistant Staphylococcus aureus Bacteremia (original) (raw)
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International journal of clinical and experimental medicine, 2015
Vancomycin is frequently used in the treatment of methicillin-resistant Staphylococcus aureus (MRSA). To determine MRSA infection status and the use of vancomycin in its treatment at a teaching hospital in China. We retrospectively reviewed 140 cases of MRSA infection that were treated from January 2013 to October 2014. We analyzed the etiology of MRSA infection and the use of vancomycin in these cases. MRSA infection mainly occurred in elderly patients concomitant with a variety of diseases, which incidence was more in men than women. More cases of MRSA infection were encountered in the ICU than in other departments. The positive culture results for MRSA were obtained in the sputum (38.57%), pharyngeal swab (19.29%), blood (5.71%), and wound secretion (11.43%) samples. The MRSA patients were sensitive to vancomycin, with the minimum inhibitory concentration (MIC) being 1 μg/mL in 53.80% of the cases and 2 μg/mL in 44.10% of the cases, respectively. Among the 35 (25%) cases treated ...
Aim: Worldwide, an estimated 2 billion healthy people carry Staphylococcus aureus (SA) and of these, up to 53 million are thought to carry methicillin-resistant SA (MRSA). MRSA bacteremia patients are more critical to manage and timely introduction of antibiotics is life-saving. The aim of the study was to elucidate the prevalence of MRSA bacteremia in different units of Teaching Hospital, Anuradhapura (THA), Sri Lanka and assess the clinical characteristics and associated mortality related to timely introduction of vancomycin therapy. Materials and Methods: The data on MRSA bacteremia which were obtained from THA, for the period of March 2012 to December 2013 were statically analyzed emphasizing the unit-wise prevalence, severity, and comorbidity and timely introduction of vancomycin therapy. Results: The laboratory records of total 13,260 blood cultures were analyzed. Of those, MRSA bacteremia was detected in 61 cultures (9.3%). The highest prevalence of MRSA bacteremia was observed in the nephrology unit. The survival rate of the patients when the vancomycin therapy started before 24 h of receiving the blood culture report was 94.9% and in the instances of the treatment started after 24 h of blood culture report, the survival rate decreased down to 50%. High Pitt Bacteraemia score (PBS) (p<0.05) and initiation of vancomycin therapy after 24 h following the receipt of blood culture report (p<0.05) independently affected the MRSA bacteremic patient's 7 th day mortality. Having comorbidities have not shown significant impact on 7 th day mortality. Conclusion: The start of vancomycin therapy as earlier as possible following arrival of antibacterial susceptibility test reduces the likelihood of mortality.
PLOS ONE
Introduction Current guidelines recommend maintaining vancomycin trough concentrations between 15-20 mg/L for serious methicillin resistant staphylococcus aureus (MRSA) infections. This recommendation is based on limited evidence. Methods A retrospective study including patients with vancomycin susceptible MRSA infections (MIC< = 2 mg/L), treated with vancomycin. We compared outcomes among patients attaining high (> = 15mg/L) vs low (<15mg/L) trough vancomycin levels. We used a propensity score to matching patients achieving low and high levels and conducted an adjusted analysis in the propensity score (PS)-matched cohort using regression analysis. Primary outcome was 30-day all-cause mortality. Results Among 285 patients included, there were no significant differences between patients achieving high and low vancomycin levels in mortality (46/131, 35.1% vs 41/154, 26.6%), clinical success, microbiological success, or nephrotoxicity. Similarly, in the PS-matched cohort (n = 162), there was no significant difference in mortality between patients with high and low vancomycin levels (24/53, 45.3% vs 57/109, 52.3%, respectively), adjusted odds ratio for mortality with high levels 0.63 (95% confidence interval 0.28-1.43). In both cohorts, patients with pneumonia achieving high levels had significantly higher clinical and microbiological success (PS-matched cohort: clinical success: 16/32, 50.0% vs 5/27, 18.5%, p =
Relevance of vancomycin susceptibility on patients outcome infected with Staphylococcus aureus
Pharmacotherapy, 2019
Background: Staphylococcus aureus is a serious pathogen with high rates of complications. We aim to study the susceptibility and outcome of S. aureus infection. Methods: A retrospective multicentre study conducted in three hospitals, Amman-Jordan. Between June 2013 and March 2014 laboratory records were reviewed for culture-positive samples growing S. aureus, also, medical records for the patients were reviewed for the demographic data, predisposing conditions, vancomycin MIC level, and outcome. Inpatients and outpatients were included, a case was classified as either hospital-associated (HA), community-associated (CA), or healthcare-associated (HCA). Data were entered as excel sheets and were statistically analyzed using SPSS version 21. Results: A total of 127 patient (46% MRSA) were culture-positive for S. aureus collected from different sources. Of these, eighty (63%) were inpatients. High resistance rates to non-β-lactam antimicrobials were recorded. Glycopeptides agents were the antibiotics of choice for the treatment of infections caused by MRSA strains. Complications rates were higher in patients with MRSA infections including mortality, whereas hospital stay was longer for patients infected with MSSA. Conclusion: Infection rates with MRSA were high among patients. There is a value for knowing vancomycin MICs for treatment of S. aureus and its implication for patients outcomes, though most outcomes were significantly worse due to MRSA infection.
Pathogens and Global Health, 2020
Background: Increased rates of Staphylococcus aureus resistance and its morbidity and mortality have raised concern about the strategy of antibiotic use. Objectives: This study aimed to determine the prevalence of methicillin-resistant S. aureus (MRSA) and vancomycin-resistant S. aureus (VRSA) isolates among Thai patients with S. aureus infection and to identify risk factors and appropriate antibiotics for these resistant strains. Methods: Data of culture-proven S. aureus isolates from clinical specimens during 2017 in King Chulalongkorn Memorial Hospital, Thailand, were retrospectively collected and classified as methicillin-sensitive S. aureus or MRSA by cefoxitin screening and oxacillin minimum inhibitory concentration by the Vitek 2 system. Each isolate was also tested for susceptibility to teicoplanin, erythromycin, clindamycin, linezolid, trimethoprim/sulfamethoxazole, ciprofloxacin, moxifloxacin, tetracycline, doxycycline, and vancomycin by Vitek 2. Demographic information and comorbidities from medical records were reviewed to identify risk factors for S. aureus infection. Results: MRSA isolates were identified in 147 (17%) of 890 patients with no different ratio in adults or children. A higher proportion of MRSA in hospital-acquired settings was observed (27% vs. 12%; p < 0.001). Comorbidities significantly associated with MRSA were chronic lung, cardiovascular, and neurological diseases. Atrial fibrillation, dementia, and benign prostatic hyperplasia were independently associated with MRSA isolation. Vancomycin was still susceptible to all kinds of infection. One VRSA isolate was from colonization. Conclusion: The prevalence of MRSA in our facility seemed to be comparatively low. Vancomycin is still an appropriate option for MRSA coverage since all S. aureus isolates in our center were sensitive to vancomycin. However, careful attention is warranted since one colonization isolate was VRSA.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014
Staphylococcus aureus is a species of bacteria that causes a number of diseases and more than 60% of it is presently resistant to methicillin. Vancomycin is the drug of choice for the eradication of methicillin-resistant S. aureus (MRSA). This study aimed to investigate the susceptibility of heterogeneous vancomycin intermediate S. aureus (hVISA) and vancomycin intermediate S. aureus (VISA) to vancomycin by standard disk diffusion, microbroth dilution, a one-point population assay, and a population analysis profile. Sixty-eight MRSA isolates from patients admitted to Sanprasitthiprasong Hospital between November 2010 and November 2011 were tested. Standard disk diffusion showed that all the MRSA isolates were susceptible to vancomycin. Vancomycin MICs for all isolates were 1-2 microg/mL. Only two MRSA isolates (2.9%) were able to grow on brain heart infusion agar supplemented with vancomycin 4 microg/mL and were confirmed by a population analysis as hVISA. This study showed the effe...
Antimicrobial Agents and Chemotherapy
The objective of this retrospective study was to compare the rates of treatment failure, which was a composite of clinical and microbiologic failure, of patients receiving vancomycin and a β-lactam to those receiving vancomycin only for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Patients 16 to 89 years of age with MRSA bacteremia admitted to a university-affiliated hospital from 1 January 2014 to 31 December 2016 were screened for study inclusion. Patients were eligible if they received >48 h of vancomycin and a β-lactam (combination group) or vancomycin only (standard group) within 48 h after bacteremia onset. A total of 182 patients were screened: 47 were included in the standard group, and 63 were in the combination group. The combination group had a higher baseline body mass index (29.2 ± 8.0 kg/m2 versus 25.8 ± 7.1 kg/m2, P = 0.022), acute physiologic assessment and chronic health evaluation-II (APACHE-II) score (median [interquartile range], 21 [15 to 26...