Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.
Division of Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Antimicrob Agents Chemother. 2018 Mar 27;62(4). doi: 10.1128/AAC.02512-17. Print 2018 Apr.
Methicillin-resistant (MRSA) is a leading cause of bacteremia and is associated with significant morbidity and mortality. Prior studies evaluating the association of vancomycin MICs with clinical outcomes in patients with MRSA bacteremia have been inconsistent. This study evaluated the association between vancomycin MICs and 30-day in-hospital mortality rates for patients with MRSA bacteremia. This was a retrospective cohort study of patients with MRSA bacteremia treated with vancomycin for ≥72 h from January 2013 to August 2016. Vancomycin MICs were determined by broth microdilution via automated susceptibility testing methods. Study groups consisted of patients with MRSA isolates that had vancomycin MICs of <2 μg/ml and those with vancomycin MICs of 2 μg/ml. Covariates included demographics, severity of illness, comorbidities, intensive-care unit (ICU) admission, infectious disease consultation, infectious sources, and hospital onset of bacteremia. The primary outcome was 30-day in-hospital mortality. Secondary outcomes included the duration of bacteremia, persistent bacteremia for ≥7 days, recurrence within 30 days, change to alternative antibiotic therapy, and length of hospital stay. Multivariate logistic regression models were analyzed to control for potential confounding variables. A total of 166 patients were included for analysis: 91 patients with vancomycin MICs of <2 μg/ml and 75 patients with vancomycin MICs of 2 μg/ml. In the multivariate logistic regression model, a vancomycin MIC of 2 μg/ml, compared to a MIC of <2 μg/ml, was not significantly associated with 30-day in-hospital mortality after adjustment for confounders. Additionally, all secondary outcomes were not statistically significantly different between study groups. In patients with MRSA bacteremia treated with vancomycin, the vancomycin MIC was not associated with differences in clinical outcomes.
耐甲氧西林金黄色葡萄球菌（MRSA）是菌血症的主要原因，与重大发病率和死亡率相关。先前评估万古霉素 MIC 与 MRSA 菌血症患者临床结局之间关联的研究结果并不一致。本研究评估了万古霉素 MIC 与 MRSA 菌血症患者 30 天院内死亡率之间的关系。这是一项回顾性队列研究，纳入了 2013 年 1 月至 2016 年 8 月期间接受万古霉素治疗≥72 小时的 MRSA 菌血症患者。通过自动化药敏试验方法，肉汤微量稀释法确定万古霉素 MIC。研究组包括万古霉素 MIC<2μg/ml 的 MRSA 分离株患者和万古霉素 MIC 为 2μg/ml 的患者。协变量包括人口统计学特征、疾病严重程度、合并症、入住重症监护病房（ICU）、传染病会诊、感染源和医院获得性菌血症。主要结局为 30 天院内死亡率。次要结局包括菌血症持续时间、≥7 天持续菌血症、30 天内复发、改变为替代抗生素治疗和住院时间。采用多变量逻辑回归模型来控制潜在的混杂变量。共纳入 166 例患者进行分析：91 例患者万古霉素 MIC<2μg/ml，75 例患者万古霉素 MIC 为 2μg/ml。在多变量逻辑回归模型中，在校正混杂因素后，万古霉素 MIC 为 2μg/ml 与 MIC<2μg/ml 相比，与 30 天院内死亡率无显著相关性。此外，两组间所有次要结局均无统计学差异。在接受万古霉素治疗的 MRSA 菌血症患者中，万古霉素 MIC 与临床结局无差异。
