Pericàs J M, Messina J A, Garcia-de-la-Mària C, Park L, Sharma-Kuinkel B K, Marco F, Wray D, Kanafani Z A, Carugati M, Durante-Mangoni E, Tattevin P, Chu V H, Moreno A, Fowler V G, Miró J M
Infectious Diseases Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
Clin Microbiol Infect. 2017 Aug;23(8):544-549. doi: 10.1016/j.cmi.2017.01.017. Epub 2017 Feb 1.
Left-sided methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis treated with cloxacillin has a poorer prognosis when the vancomycin minimum inhibitory concentration (MIC) is ≥1.5 mg/L. We aimed to validate this using the International Collaboration on Endocarditis cohort and to analyse whether specific genetic characteristics were associated with a high vancomycin MIC (≥1.5 mg/L) phenotype.
All patients with left-sided MSSA infective endocarditis treated with antistaphylococcal β-lactam antibiotics between 2000 and 2006 with available isolates were included. Vancomycin MIC was determined by Etest as either high (≥1.5 mg/L) or low (<1.5 mg/L). Isolates underwent spa typing to infer clonal complexes and multiplex PCR for identifying virulence genes. Univariate analysis was performed to evaluate the association between in-hospital and 1-year mortality, and vancomycin MIC phenotype.
Sixty-two cases met the inclusion criteria. Vancomycin MIC was low in 28 cases (45%) and high in 34 cases (55%). No significant differences in patient demographic data or characteristics of infection were observed between patients with infective endocarditis due to high and low vancomycin MIC isolates. Isolates with high and low vancomycin MIC had similar distributions of virulence genes and clonal lineages. In-hospital and 1-year mortality did not differ significantly between the two groups (32% (9/28) vs. 27% (9/34), p 0.780; and 43% (12/28) vs. 29% (10/34), p 0.298, for low and high vancomycin MIC respectively).
In this international cohort of patients with left-sided MSSA endocarditis treated with antistaphylococcal β-lactams, vancomycin MIC phenotype was not associated with patient demographics, clinical outcome or virulence gene repertoire.
当万古霉素最低抑菌浓度（MIC）≥1.5mg/L时，用氯唑西林治疗的左侧甲氧西林敏感金黄色葡萄球菌（MSSA）心内膜炎预后较差。我们旨在利用国际心内膜炎协作队列对此进行验证，并分析特定基因特征是否与高万古霉素MIC（≥1.5mg/L）表型相关。
纳入2000年至2006年间接受抗葡萄球菌β-内酰胺类抗生素治疗且有可用分离株的所有左侧MSSA感染性心内膜炎患者。通过Etest测定万古霉素MIC，分为高（≥1.5mg/L）或低（<1.5mg/L）。对分离株进行spa分型以推断克隆复合体，并进行多重PCR以鉴定毒力基因。进行单因素分析以评估住院和1年死亡率与万古霉素MIC表型之间的关联。
62例符合纳入标准。28例（45%）万古霉素MIC低，34例（55%）高。万古霉素MIC高和低的感染性心内膜炎患者在患者人口统计学数据或感染特征方面未观察到显著差异。万古霉素MIC高和低的分离株在毒力基因和克隆谱系分布上相似。两组的住院和1年死亡率无显著差异（万古霉素MIC低和高分别为32%（9/28）对27%（9/34），p=0.780；43%（12/28）对29%（10/34），p=0.298）。
在这个接受抗葡萄球菌β-内酰胺类治疗的左侧MSSA心内膜炎国际患者队列中，万古霉素MIC表型与患者人口统计学、临床结局或毒力基因库无关。
