RT Journal Article
T1 High vancomycin MICs predict the development of infective endocarditis in patients with catheter-related bacteraemia due to methicillin-resistant Staphylococcus aureus.
A1 San-Juan, Rafael
A1 Fernández-Ruiz, Mario
A1 Gasch, Oriol
A1 Camoez, Mariana
A1 López-Medrano, Francisco
A1 Domínguez, María Ángeles
A1 Almirante, Benito
A1 Padilla, Belén
A1 Pujol, Miquel
A1 Aguado, José María
A1 REIPI/GEIH Study Group, 
AB It has been suggested that there is an increased risk of treatment failure in episodes of MRSA bloodstream infection (BSI) caused by strains with high vancomycin MICs. However, it is unknown if this phenomenon may also act as a risk factor for the development of infective endocarditis (IE). We analysed 207 episodes of catheter-related (CR)-BSI recruited from June 2008 to December 2009 within a prospective study on MRSA BSI in 21 Spanish hospitals. Vancomycin susceptibility was centrally tested. The impact of high vancomycin MIC values (≥1.5 mg/L by Etest) on the subsequent development of IE was investigated by Cox regression. High vancomycin MIC values were observed in 46.9% of the isolates. Initial therapy consisted of vancomycin [99 episodes (44.7%)], daptomycin [25 (12.1%)], linezolid [18 (8.7%)] and other antistaphylococcal agents [16 (7.7%)]. Haematogenous complications occurred in 41 patients (19.8%), including 10 episodes complicated by IE. Early (48 h) and late (30 day) all-cause mortality were 3.4% and 25.1%, respectively. High vancomycin MIC isolates were more common among patients that developed IE compared with those free from this complication [90.9% (9/10) versus 44.7% (88/197); P  = 0.007]. This association remained significant after adjusting for multiple confounders (including initial antibiotic therapy and catheter removal) in different models (minimum hazard ratio: 9.18; 95% CI: 1.16-72.78; P  = 0.036). There were no differences in mortality according to vancomycin MIC values. Decreased susceptibility to vancomycin acted as a predictor of the development of IE complicating MRSA CR-BSI.
YR 2017
FD 2017
LK https://hdl.handle.net/10668/25947
UL https://hdl.handle.net/10668/25947
LA en
DS RISalud
RD Apr 6, 2025