Rose Dusten T, Moskhos Alexander, Wibisono Arya, Reveles Kelly R
Ascension Seton, Dell Seton Medical Center at The University of Texas, Department of Pharmacy, Austin, TX, USA; College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
Ascension Seton, Dell Seton Medical Center at The University of Texas, Department of Pharmacy, Austin, TX, USA; College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
Int J Infect Dis. 2022 Apr;117:179-186. doi: 10.1016/j.ijid.2022.02.002. Epub 2022 Feb 5.
Variability in minimum inhibitory concentration (MIC) with automated susceptibility testing instruments may influence methicillin-resistant Staphylococcus aureus (MRSA) treatment. The purpose of this study was to evaluate the difference in vancomycin MIC values and the impact on vancomycin alternative therapy for MRSA bacteremia using the MicroScan and VITEK 2 automated systems.
This was a retrospective multicenter cohort study of adult patients with MRSA bacteremia. Patients were stratified by susceptibility testing with MicroScan (May 2013-December 2016) or VITEK 2 (June 2017-February 2020). The primary outcome was vancomycin alternative therapy use. Secondary endpoints included MRSA MIC, 30-day mortality, 30- and 90-day readmission, and hospital length of stay (LOS).
A total of 193 patients were included for analysis: 89 in the MicroScan group and 104 in the VITEK 2 group. Vancomycin alternative therapy use was higher in the MicroScan group than the VITEK 2 group (56.2% vs 20.2%; p <0.001). Median MIC value was 2 mg/L and 1 mg/L for MicroScan and VITEK 2, respectively (p <0.001). Median hospital LOS was shorter in the VITEK 2 period (16 vs 12 days; p = 0.02). Thirty-day mortality (10.1% vs 7.7%; p = 0.555) and 90-day readmission (34.8% vs 29.8%; p = 0.457) did not significantly differ between MicroScan and VITEK 2 groups.
VITEK 2 use was associated with lower reported vancomycin MICs and less use of vancomycin alternative therapy.
使用自动化药敏检测仪器时，最低抑菌浓度（MIC）的变异性可能会影响耐甲氧西林金黄色葡萄球菌（MRSA）的治疗。本研究的目的是评估使用MicroScan和VITEK 2自动化系统时，万古霉素MIC值的差异以及对MRSA菌血症万古霉素替代疗法的影响。
这是一项针对成年MRSA菌血症患者的回顾性多中心队列研究。患者根据使用MicroScan（2013年5月至2016年12月）或VITEK 2（2017年6月至2020年2月）进行的药敏检测进行分层。主要结局是万古霉素替代疗法的使用情况。次要终点包括MRSA MIC、30天死亡率、30天和90天再入院率以及住院时间（LOS）。
共有193例患者纳入分析：MicroScan组89例，VITEK 2组104例。MicroScan组万古霉素替代疗法的使用率高于VITEK 2组（56.2%对20.2%；p<0.001）。MicroScan和VITEK 2的MIC中位数分别为2mg/L和1mg/L（p<0.001）。VITEK 2时期的住院时间中位数较短（16天对12天；p=0.02）。MicroScan组和VITEK 2组之间的30天死亡率（10.1%对7.7%；p=0.555）和90天再入院率（34.8%对29.8%；p=0.457）无显著差异。
使用VITEK 2与报告的万古霉素MIC较低以及万古霉素替代疗法使用较少相关。
