Abstract
BackgroundThe present study was designed to investigate whether teicoplanin minimum inhibitory concentrations (MICs) of methicillin-resistant Staphylococcus aureus (MRSA) isolates play a role in the prognosis of patient with teicoplanin-treated MRSA bloodstream infection (BSI).MethodsBetween 1 January 2006 and 31 December 2009, adult patients with teicoplanin-treated MRSA BSI in two Taiwan medical centers were retrospectively enrolled. Their blood MRSA isolates were submitted for determination of MICs to various antibiotics and multi-locus sequence types. All-cause mortalities on Days 14 and 30, as well as clinical response at the end of teicoplanin therapy were treated as endpoints.ResultsTwo hundred seventy adult patients were enrolled and 210 blood MRSA isolates were available. Independent risk factors for un-favorable outcome at the end of teicoplanin therapy included septic shock (p < 0.0001) and an elevated C-reactive protein level (p = 0.0064). The independent risk factors for all-cause Day 14 mortality (13.0%) included the presence of auto-immune diseases (p = 0.0235), septic shock (p = 0.0253) and thrombocytopenia (p = 0.0018). The independent risk factors for all-cause Day 30 mortality (26.3%) included age (p = 0.0102), septic shock (p < 0.0001) and thrombocytopenia (p = 0.0059).ConclusionsThe current study didn’t find a significant role for teicoplanin MICs in the prognosis of adult patients with teicoplanin-treated MRSA BSI.
Highlights
The present study was designed to investigate whether teicoplanin minimum inhibitory concentrations (MICs) of methicillin-resistant Staphylococcus aureus (MRSA) isolates play a role in the prognosis of patient with teicoplanin-treated MRSA bloodstream infection (BSI)
Patients and data collection Between 1 January 2006 and 31 December 2009, all adult patients admitted to Taipei Veterans General Hospital (TVGH, a major tertiary teaching hospital with 2,900 beds located in northern Taiwan) and National Taiwan University Hospital (NTUH, a major tertiary teaching hospital with 2,500 beds located in northern Taiwan) with MRSA BSIs and no concomitant infections caused by other organisms were potential study participants
The present study demonstrated that all-cause Day 14 and Day 30 mortalities of adult patients with MRSA BSIs treated by teicoplanin were 13.0% and 26.3%, respectively, which is in agreement with prior studies
Summary
The present study was designed to investigate whether teicoplanin minimum inhibitory concentrations (MICs) of methicillin-resistant Staphylococcus aureus (MRSA) isolates play a role in the prognosis of patient with teicoplanin-treated MRSA bloodstream infection (BSI). A possible basis for this observation is that an AUC/MIC ratio ≥ 400 is required to achieve clinical effectiveness when using vancomycin to treat S. aureus infections [10]; this target is difficult to achieve if the causative MRSA isolates have a vancomycin MIC > 1 mg/L [10]. Another possible explanation is that a higher proportion of heterogenous vancomycin-intermediate S. aureus (hVISA) has been noted among MRSA with higher vancomycin MICs [11]
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