Intensive Care Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Intensive Care Unit, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Intensive Care Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
J Glob Antimicrob Resist. 2018 Sep;14:141-144. doi: 10.1016/j.jgar.2018.03.007. Epub 2018 Mar 27.
The aim of this study was to determine the persistence of the adverse prognostic effect of elevated vancomycin minimum inhibitory concentration (MIC) in methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in a setting with low vancomycin use.
A retrospective study focusing on episodes of bacteraemia due to MRSA diagnosed from January 2010 through December 2015 was designed. The main outcome measures were 30-day mortality and treatment failure. Multivariate logistic regression analysis was used to identify variables associated with patient mortality and treatment outcome.
In total, 79 MRSA bacteraemia episodes were included. The vancomycin MIC was >1.0μg/mL in 53 episodes (67.1%). The presence of high vancomycin MIC was not associated with a higher mortality rate or treatment success. A daptomycin MIC≥0.5μg/mL was present in 16 (26.2%) of 61 episodes for which the daptomycin MIC was obtained and was associated with 30-day mortality in the multivariate analysis (odds ratio=4.72, 95% confidence interval 1.19-18.71). None of the antimicrobials used were associated with a lower risk of treatment failure or mortality.
The pernicious effect of high vancomycin MIC disappears in the absence of a predominant use of this antibiotic. However, a high daptomycin MIC in MRSA bacteraemia is associated with higher mortality in patients with bacteraemia, irrespective of antimicrobial treatment choice.
本研究旨在确定在万古霉素使用量较低的情况下，耐甲氧西林金黄色葡萄球菌（MRSA）菌血症中升高的万古霉素最小抑菌浓度（MIC）不良预后的持续存在。
设计了一项回顾性研究，重点关注 2010 年 1 月至 2015 年 12 月期间诊断为 MRSA 菌血症的病例。主要结局指标为 30 天死亡率和治疗失败。采用多变量逻辑回归分析确定与患者死亡率和治疗结果相关的变量。
共纳入 79 例 MRSA 菌血症发作。53 例（67.1%）的万古霉素 MIC 值＞1.0μg/mL。高万古霉素 MIC 值与更高的死亡率或治疗成功率无关。在获得达托霉素 MIC 值的 61 例病例中，有 16 例（26.2%）达托霉素 MIC 值≥0.5μg/mL，在多变量分析中与 30 天死亡率相关（比值比=4.72，95%置信区间 1.19-18.71）。使用的任何一种抗菌药物均与治疗失败或死亡率的风险降低无关。
在没有大量使用万古霉素的情况下，高万古霉素 MIC 的有害影响消失。然而，在 MRSA 菌血症中，高达托霉素 MIC 与菌血症患者的死亡率升高相关，而与抗菌药物治疗选择无关。
