Reduced Vancomycin Susceptibility of Methicillin-Susceptible Staphylococcus aureus Has No Significant Impact on Mortality but Results in an Increase in Complicated Infection

Antimicrobial Agents and Chemotherapy
Sean B SullivanAnne-Catrin Uhlemann

Abstract

Methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSIs) often lead to severe complications despite the availability of effective antibiotics. It remains unclear whether elevated vancomycin MICs are associated with worse outcomes. We conducted a 2-year retrospective cohort study (n = 252) of patients with MSSA BSIs at a tertiary care hospital. We defined reduced vancomycin susceptibility (RVS) as a Microscan MIC of 2 mg/liter. All strains were genotyped (spa) and assessed for agr functionality. Multivariable logistic regression models were used to examine the impact of RVS phenotype and strain genotype on 30-day all-cause mortality and complicated bacteremia (metastatic spread, endovascular infection, or duration ≥3 days). One-third of patients (84/252) were infected with RVS isolates. RVS Infections were more frequently associated with metastatic or embolic sites of infection (36% versus 17%, P < 0.001), and endovascular infection (26% versus 12%, P = 0.004). These infections occurred more often in patients with fewer underlying comorbidities (Charlson comorbidity index of ≥3 [73% versus 88%, P = 0.002]). Genotyping identified 127 spa-types and 14 Spa-clonal complexes (Spa-CCs). Spa-CC002 and Spa-CC00...Continue Reading

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Citations

Mar 7, 2018·BMC Infectious Diseases·Natasha E HolmesUNKNOWN VANESSA study group, on behalf of the Australasian Society for Infectious Diseases (ASID) Clinical Research Network (CRN)
Feb 8, 2019·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·Rocío FalcónDavid Navarro
Nov 17, 2020·The Pediatric Infectious Disease Journal·Ethan CantyJessica E Ericson
Jul 7, 2021·Expert Opinion on Drug Metabolism & Toxicology·Joao Paulo TellesFelipe Francisco Tuon

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