Clinical features and treatment outcomes of vancomycin-intermediate Staphylococcus aureus (VISA) and heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) in a tertiary care institution in Singapore
Clinical features and treatment outcomes of vancomycin-intermediate Staphylococcus aureus (VISA) and heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) in a tertiary care institution in Singapore
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DOI：
10.1007/s10096-009-0741-5
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发表时间：
2009-08-01
影响因子：
4.5
通讯作者：
Kurup, A.
中科院分区：
文献类型：
--
作者：
Fong, R. K. C.;Low, J.;Kurup, A.
这项回顾性病例对照研究回顾了异源耐药的万古霉素中间金黄色葡萄球菌(HVISA)和万古霉素中间金黄色葡萄球菌(VISA)感染的临床特征及其对临床结局的局部影响。与对万古霉素敏感的金黄色葡萄球菌(n=30)相比，hVISA和VISA感染(n=10)被发现与先前使用糖肽的时间(P=0.01)、骨/关节(P<；0.01)和假体感染(P=0.04)以及治疗失败有关，如较长的菌血症(P<；0.01)和培养阳性(P<；0.01)。据观察，这导致了更长的住院时间(P<；0.01)和总的抗生素治疗时间(P=0.01)。但两组的总病死率和住院费用无显著差异(P=0.12)。临床医生应该认识到hVISA/VISA与高细菌载量的深层感染之间的关联。我们建议对甲氧西林耐药金黄色葡萄球菌(MRSA)感染的hVISA/VISA进行有针对性的甚至普遍的筛查。
This retrospective case-control study was undertaken to review the clinical features associated with heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) and vancomycin-intermediate S. aureus (VISA) infections and the local impact they have on clinical outcome. Compared with vancomycin-susceptible S. aureus (n = 30), hVISA and VISA infections (n = 10) are found to be associated with a longer period of prior glycopeptide use (P = 0.01), bone/joint (P < 0.01) and prosthetic infections (P = 0.04), as well as treatment failure, as evidenced by longer bacteremic (P < 0.01) and culture positivity (P < 0.01) periods. This was observed to have resulted in longer hospital length of stay (P < 0.01) and total antibiotic therapy duration (P = 0.01). There was, however, no significant difference in the overall patient mortality or the hospitalization cost (P = 0.12) in both groups. Clinicians should be cognizant of the association between hVISA/VISA with high bacterial load deep-seated infections. We recommend targeted and even universal screening for hVISA/VISA in methicillin-resistant S. aureus (MRSA) infections.