High prevalence of isolates with reduced glycopeptide susceptibility in persistent or recurrent bloodstream infections due to methicillin-resistant Staphylococcus aureus
| Autor: | Louis Bernard, Patrice Francois, Daniel Pablo Lew, Jacques Schrenzel, Adriana Renzoni, Marta Buzzi, Stéphan Juergen Harbarth, Pierre Vaudaux, Tristan Ferry, Elzbieta Huggler, Ilker Uçkay |
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| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Male
Drug Resistance Bacterial/drug effects Bacteremia medicine.disease_cause 0302 clinical medicine Recurrence Medicine Pharmacology (medical) 030212 general & internal medicine Staphylococcal Infections/drug therapy/microbiology ddc:616 Aged 80 and over 0303 health sciences High prevalence Teicoplanin Staphylococcal Infections Middle Aged Glycopeptide Anti-Bacterial Agents 3. Good health Vancomycin/pharmacology/therapeutic use Infectious Diseases Staphylococcus aureus Child Preschool Vancomycin Female Anti-Bacterial Agents/pharmacology/therapeutic use medicine.drug Methicillin-Resistant Staphylococcus aureus Bacteremia/drug therapy/microbiology Microbial Sensitivity Tests Clinical Therapeutics Microbiology 03 medical and health sciences Drug Resistance Bacterial Teicoplanin/pharmacology/therapeutic use Humans Risk factor Aged Retrospective Studies Pharmacology Methicillin-Resistant Staphylococcus aureus/drug effects/growth & development/isolation & purification 030306 microbiology business.industry Retrospective cohort study biochemical phenomena metabolism and nutrition bacterial infections and mycoses Methicillin-resistant Staphylococcus aureus business |
| Zdroj: | Antimicrobial Agents and Chemotherapy, Vol. 56, No 3 (2012) pp. 1258-64 Antimicrobial agents and chemotherapy |
| ISSN: | 0066-4804 |
| Popis: | Reduced susceptibility to glycopeptides in methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates is considered a risk factor for failure of glycopeptide therapy. We compared the prevalences of MRSA isolates with reduced glycopeptide susceptibility in patients with versus without persistent or recurrent MRSA bloodstream infections. A retrospective cohort study at the University Hospital of Geneva identified 27 patients with persistent or recurrent clonally related MRSA bacteremic episodes over an 8-year period, which included 208 consecutive nosocomial MRSA bacteremic episodes. Vancomycin and teicoplanin MICs were determined by a modified macrodilution assay allowing improved detection of glycopeptide-intermediate MRSA isolates (GISA), characterized by elevated teicoplanin or/and vancomycin MICs (≥4 μg/ml). For 16 patients (59%), their pretherapy and/or posttherapy MRSA isolates showed elevated teicoplanin MICs, among which 10 (37%) concomitantly displayed elevated vancomycin MICs. In contrast, 11 other patients (41%) were persistently or recurrently infected with non-GISA isolates. In comparison, only 39 (22%) of 181 single isolates from patients with no microbiological evidence of persistent or recurrent infections showed elevated teicoplanin MICs, among which 14 (8%) concomitantly displayed elevated vancomycin MICs. Clinical, microbiological, and pharmacokinetic variables for patients persistently or recurrently infected with GISA or non-GISA isolates were similar. Bacteremic patients with a poor response to glycopeptide therapy had a 2.8-fold- and 4.8-fold-higher rates of MRSA isolates displaying elevated teicoplanin and vancomycin MICs, respectively, than patients with single isolates ( P < 0.0001). Detection of elevated teicoplanin MICs may help to predict a poor response to glycopeptide therapy in MRSA bacteremic patients. |
| Databáze: | OpenAIRE |
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