Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
J Microbiol Immunol Infect. 2013 Jun;46(3):210-6. doi: 10.1016/j.jmii.2012.06.010. Epub 2012 Sep 19.
BACKGROUND/PURPOSE: The objective of this study was to determine the predictive value of teicoplanin minimal inhibitory concentrations (MICs) for treatment failure among patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.
In this study, all patients with ≥1 tracheal aspirates or sputum cultures positive for MRSA admitted to the hospital between April 2011 and September 2011 were reviewed. We enrolled patients who are ≥18 years of age, with a diagnosis of pneumonia, and with a receipt of teicoplanin therapy throughout the course. The relationship between teicoplanin Etest MICs and treatment outcomes of MRSA pneumonia was analyzed to identify the breakpoint of teicoplanin MICs influencing treatment outcomes.
Of the 80 patients enrolled, 31 had a lower teicoplanin MIC level (<2.0 mg/L) and 49 had a higher MIC level (≥2.0 mg/L) for MRSA. The lower MIC group had a higher clinical resolution rate in 14 days [24 (77.4%) vs. 23 (46.9%), p = 0.007] and a lower treatment failure rate at the end of teicoplanin treatment [4 (12.9%) vs. 18 (36.7%), p = 0.020]. A comparison between the treatment success and failure groups showed that the former had a longer duration of teicoplanin use (18.76 ± 10.34vs.12.41 ± 5.65 days; p = 0.014). Results of a multivariate analysis showed that teicoplanin MICs ≥ 2.0 mg/Land shorter duration of teicoplanin therapy were independent risk factors for treatment failure.
A higher teicoplanin MIC value (≥2.0 mg/L) may predict the treatment failure among patients with teicoplanin-treated MRSA pneumonia.
背景/目的：本研究旨在确定耐甲氧西林金黄色葡萄球菌（MRSA）肺炎患者中替考拉宁最小抑菌浓度（MIC）对治疗失败的预测价值。
本研究回顾了 2011 年 4 月至 2011 年 9 月期间因 MRSA 定植于气管抽吸物或痰培养阳性而住院的所有患者。纳入标准为年龄≥18 岁、诊断为肺炎且在整个治疗过程中接受替考拉宁治疗的患者。分析了替考拉宁 Etest MIC 值与 MRSA 肺炎治疗结果之间的关系，以确定影响治疗结果的替考拉宁 MIC 值的临界点。
在纳入的 80 例患者中，31 例患者的替考拉宁 MIC 水平较低（＜2.0mg/L），49 例患者的 MIC 水平较高（≥2.0mg/L）。较低 MIC 组在 14 天内的临床缓解率较高[24（77.4%）比 23（46.9%），p=0.007]，替考拉宁治疗结束时的治疗失败率较低[4（12.9%）比 18（36.7%），p=0.020]。治疗成功组和失败组的比较显示，前者的替考拉宁使用时间更长[18.76±10.34比 12.41±5.65 天；p=0.014]。多变量分析结果表明，替考拉宁 MIC 值≥2.0mg/L 和替考拉宁治疗时间较短是治疗失败的独立危险因素。
较高的替考拉宁 MIC 值（≥2.0mg/L）可能预测替考拉宁治疗的 MRSA 肺炎患者的治疗失败。
