Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia
Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia
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DOI：
10.1128/jcm.42.6.2398-2402.2004
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发表时间：
2004-06-01
影响因子：
9.4
通讯作者：
Eliopoulos, GM
中科院分区：
文献类型：
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作者：
Sakoulas, G;Moise-Broder, PA;Eliopoulos, GM
我们试图找出耐甲氧西林金黄色葡萄球菌（MRSA）血流分离株的微生物学特性与万古霉素治疗菌血症的疗效之间的关系。进行万古霉素敏感性试验，并确定来自30名不同MRSA菌血症患者的30株分离株的杀菌活性，这些患者的临床和微生物学结局数据可用。这些患者中的大多数以前曾参加过常规万古霉素治疗难治性MRSA菌血症的多中心前瞻性研究。Logistic回归发现万古霉素治疗成功率与万古霉素MIC（小于或等于50.5 μ g/ml vs 1.0 - 2.0 μ g/ml; P = 0.02）和万古霉素体外培养72小时的杀灭程度（log（10）CFU/ml的降低）之间存在统计学显著相关性（P = 0.03）。对于万古霉素MIC小于或等于0.5 μ g/ml的MRSA分离株，万古霉素治疗菌血症的成功率为55.6%，而万古霉素对MRSA的MIC为1 - 2 μ g/ml的病例仅有9.5%有效。万古霉素在体外72 It时能更有效地杀死MRSA的患者，万古霉素治疗菌血症的临床成功率更高（log（10）< 4.71 [n = 9]，0%; log（10）4.71至6.26 [n = 13]，23.1%; log（10）> 6.27 [n = 8]，50%）。我们的结论是，随着万古霉素MIC在敏感范围内的增加，MRSA菌血症中万古霉素治疗失败的显著风险开始出现。阐明S.金黄色葡萄球菌应开始检查在万古霉素产生明显耐药性之前开始表现出敏感性变化的细菌。万古霉素治疗MRSA菌血症的预后信息也可以通过检测万古霉素的体外杀菌效力获得。
We attempted to find a relationship between the microbiological properties of bloodstream isolates of methicillin-resistant Staphylococcus aureus (MRSA) and the efficacy of vancomycin in the treatment of bacteremia. Vancomycin susceptibility testing was performed, and bactericidal activity was determined for 30 isolates from 30 different patients with MRSA bacteremia for whom clinical and microbiological outcome data were available. The majority of these patients had been previously enrolled in multicenter prospective studies of MRSA bacteremia refractory to conventional vancomycin therapy. Logistic regression found a statistically significant relationship between treatment success with vancomycin and decreases in both vancomycin MICs (less than or equal to50.5 mug/ml versus 1.0 to 2.0 mug/ml; P = 0.02) and degree of killing (reduction in log(10) CFU/milliliter) by vancomycin over 72 h of incubation in vitro (P = 0.03). For MRSA isolates with vancomycin MICs less than or equal to 0.5 mug/ml, vancomycin was 55.6% successful in the treatment of bacteremia whereas vancomycin was only 9.5% effective in cases in which vancomycin MICs for MRSA were 1 to 2 mug/ml. Patients with MRSA that was more effectively killed at 72 It by vancomycin in vitro had a higher clinical success rate with vancomycin therapy in the treatment of bacteremia (log(10) < 4.71 [n = 9], 0%; log(10) 4.71 to 6.26 [n = 13], 23.1%; log(10) > 6.27 [n = 8], 50%). We conclude that a significant risk for vancomycin treatment failure in MRSA bacteremia begins to emerge with increasing vancomycin MICs well within the susceptible range. Elucidating the mechanisms involved in intermediate-level glycopeptide resistance in S. aureus should begin by examining bacteria that begin to show changes in vancomycin susceptibility before the development of obvious resistance. Prognostic information for vancomycin treatment outcome in MRSA bacteremia may also be obtained by testing the in vitro bactericidal potency of vancomycin.