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- Title
Effect of Vancomycin Minimal Inhibitory Concentration on the Outcome of Methicillin-Susceptible Staphylococcus aureus Endocarditis.
- Authors
Cervera, Carlos; Castañeda, Ximena; de la Maria, Cristina Garcia; del Rio, Ana; Moreno, Asunción; Soy, Dolors; Pericas, Juan Manuel; Falces, Carlos; Armero, Yolanda; Almela, Manel; Ninot, Salvador; Pare, Juan Carlos; Mestres, Carlos A.; Gatell, Jose M.; Marco, Francesc; Miro, Jose M.
- Abstract
In this retrospective analysis of a prospectively collected cohort of 93 patients with left-sided endocarditis caused by methicillin-susceptible Staphylococcus aureus treated with cloxacillin, in-hospital mortality was 3-fold higher in patients with endocarditis caused by strains with a vancomycin minimum inhibitory concentration ≥ 1.5 µg/mL.Background. Staphylococcus aureus endocarditis has a high mortality rate. Vancomycin minimum inhibitory concentration (MIC) has been shown to affect the outcome of methicillin-resistant S. aureus bacteremia, and recent data point to a similar effect on methicillin-susceptible S. aureus bacteremia. We aimed to evaluate the effect of vancomycin MIC on left-sided S. aureus infective endocarditis (IE) treated with cloxacillin.Methods. We analyzed a prospectively collected cohort of patients with IE in a single tertiary-care hospital. Vancomycin, daptomycin, and cloxacillin MIC was determined by E-test. S. aureus strains were categorized as low vancomycin MIC (<1.5 µg/mL) and high vancomycin MIC (≥1.5 µg/mL). The primary endpoint was in-hospital mortality.Results. We analyzed 93 patients with left-sided IE treated with cloxacillin, of whom 53 (57%) had a vancomycin MIC < 1.5 µg/mL and 40 (43%) a vancomycin MIC ≥ 1.5 µg/mL. In-hospital mortality was 30% (n = 16/53) in patients with a low vancomycin MIC and 53% (n = 21/40) in those with a high vancomycin MIC (P = .03). No correlation was found between oxacillin MIC and vancomycin or daptomycin MIC. Logistic regression analysis showed that higher vancomycin MIC increased in-hospital mortality 3-fold (odds ratio, 3.1; 95% confidence interval, 1.2–8.2) after adjustment for age, year of diagnosis, septic complications, and nonseptic complicated endocarditis.Conclusions. Our results indicate that vancomycin MIC could be used to identify a subgroup of patients with methicillin-susceptible S. aureus IE at risk of higher mortality. The worse outcome of staphylococcal infections with a higher vancomycin MIC cannot be explained solely by suboptimal pharmacokinetics of antibiotics.
- Subjects
STAPHYLOCOCCUS aureus infections; CLOXACILLIN; VANCOMYCIN; INFECTIVE endocarditis; ANTIBIOTICS; ENDOCARDITIS
- Publication
Clinical Infectious Diseases, 2014, Vol 58, Issue 12, p1668
- ISSN
1058-4838
- Publication type
Article