Vancomycin heteroresistance is associated with reduced mortality in ST239 methicillin-resistant Staphylococcus aureus blood stream infections.

<h4>Background</h4>Despite hVISA infections being associated with vancomycin treatment failure, no previous study has been able to detect a mortality difference between heteroresistant vancomycin intermediate Staphylococcus aureus (hVISA) and vancomycin susceptible Staphylococcus aureus...

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Autores principales:	Sebastiaan J van Hal, Mark Jones, Iain B Gosbell, David L Paterson
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/993e4514d1c54360a08074e609886d69
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spelling	oai:doaj.org-article:993e4514d1c54360a08074e609886d692021-11-18T06:51:39ZVancomycin heteroresistance is associated with reduced mortality in ST239 methicillin-resistant Staphylococcus aureus blood stream infections.1932-620310.1371/journal.pone.0021217https://doaj.org/article/993e4514d1c54360a08074e609886d692011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21713004/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Despite hVISA infections being associated with vancomycin treatment failure, no previous study has been able to detect a mortality difference between heteroresistant vancomycin intermediate Staphylococcus aureus (hVISA) and vancomycin susceptible Staphylococcus aureus (VSSA) bloodstream infections (BSI).<h4>Methodology</h4>Consecutive methicillin-resistant S. aureus (MRSA) BSI episodes between 1996 and 2008 were reviewed. Patient demographics, clinical presentation, treatment and overall mortality at 30 days were extracted from the medical records. All isolates underwent vancomycin minimum inhibitory concentration (VMIC) testing by broth microdilution and Etest. hVISA was confirmed by population analysis profiling using the area under the curve method (PAP-AUC).<h4>Principal findings</h4>401 evaluable MRSA BSI episodes were identified over the 12 years. Of these, 46 (11.5%) and 2 (0.5%) were confirmed as hVISA and VISA by PAP-AUC respectively. hVISA predominantly occurred in ST239-like MRSA isolates with high VMIC (2 mg/L). Compared to VSSA, hVISA was associated with chronic renal failure (p<0.001), device related infections (haemodialysis access) (p<0.001) and previous vancomycin usage (p = 0.004). On multivariate analysis, independent predictors of mortality included age, presence of multiple co-morbidities, principal diagnosis, transit to ICU and severity of illness while infection related surgery and hVISA phenotype were associated with increased survival.<h4>Conclusions/significance</h4>The presence of hVISA is dependent on the appropriate interplay between host and pathogen factors. hVISA in ST239 MRSA is an independent predictor of survival. Whether these findings would be replicated across all MRSA clones is unknown and warrants further study.Sebastiaan J van HalMark JonesIain B GosbellDavid L PatersonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 6, p e21217 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Sebastiaan J van Hal Mark Jones Iain B Gosbell David L Paterson Vancomycin heteroresistance is associated with reduced mortality in ST239 methicillin-resistant Staphylococcus aureus blood stream infections.
description	<h4>Background</h4>Despite hVISA infections being associated with vancomycin treatment failure, no previous study has been able to detect a mortality difference between heteroresistant vancomycin intermediate Staphylococcus aureus (hVISA) and vancomycin susceptible Staphylococcus aureus (VSSA) bloodstream infections (BSI).<h4>Methodology</h4>Consecutive methicillin-resistant S. aureus (MRSA) BSI episodes between 1996 and 2008 were reviewed. Patient demographics, clinical presentation, treatment and overall mortality at 30 days were extracted from the medical records. All isolates underwent vancomycin minimum inhibitory concentration (VMIC) testing by broth microdilution and Etest. hVISA was confirmed by population analysis profiling using the area under the curve method (PAP-AUC).<h4>Principal findings</h4>401 evaluable MRSA BSI episodes were identified over the 12 years. Of these, 46 (11.5%) and 2 (0.5%) were confirmed as hVISA and VISA by PAP-AUC respectively. hVISA predominantly occurred in ST239-like MRSA isolates with high VMIC (2 mg/L). Compared to VSSA, hVISA was associated with chronic renal failure (p<0.001), device related infections (haemodialysis access) (p<0.001) and previous vancomycin usage (p = 0.004). On multivariate analysis, independent predictors of mortality included age, presence of multiple co-morbidities, principal diagnosis, transit to ICU and severity of illness while infection related surgery and hVISA phenotype were associated with increased survival.<h4>Conclusions/significance</h4>The presence of hVISA is dependent on the appropriate interplay between host and pathogen factors. hVISA in ST239 MRSA is an independent predictor of survival. Whether these findings would be replicated across all MRSA clones is unknown and warrants further study.
format	article
author	Sebastiaan J van Hal Mark Jones Iain B Gosbell David L Paterson
author_facet	Sebastiaan J van Hal Mark Jones Iain B Gosbell David L Paterson
author_sort	Sebastiaan J van Hal
title	Vancomycin heteroresistance is associated with reduced mortality in ST239 methicillin-resistant Staphylococcus aureus blood stream infections.
title_short	Vancomycin heteroresistance is associated with reduced mortality in ST239 methicillin-resistant Staphylococcus aureus blood stream infections.
title_full	Vancomycin heteroresistance is associated with reduced mortality in ST239 methicillin-resistant Staphylococcus aureus blood stream infections.
title_fullStr	Vancomycin heteroresistance is associated with reduced mortality in ST239 methicillin-resistant Staphylococcus aureus blood stream infections.
title_full_unstemmed	Vancomycin heteroresistance is associated with reduced mortality in ST239 methicillin-resistant Staphylococcus aureus blood stream infections.
title_sort	vancomycin heteroresistance is associated with reduced mortality in st239 methicillin-resistant staphylococcus aureus blood stream infections.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/993e4514d1c54360a08074e609886d69
work_keys_str_mv	AT sebastiaanjvanhal vancomycinheteroresistanceisassociatedwithreducedmortalityinst239methicillinresistantstaphylococcusaureusbloodstreaminfections AT markjones vancomycinheteroresistanceisassociatedwithreducedmortalityinst239methicillinresistantstaphylococcusaureusbloodstreaminfections AT iainbgosbell vancomycinheteroresistanceisassociatedwithreducedmortalityinst239methicillinresistantstaphylococcusaureusbloodstreaminfections AT davidlpaterson vancomycinheteroresistanceisassociatedwithreducedmortalityinst239methicillinresistantstaphylococcusaureusbloodstreaminfections
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Vancomycin heteroresistance is associated with reduced mortality in ST239 methicillin-resistant Staphylococcus aureus blood stream infections.

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