Comparison of the clinical features, bacterial genotypes and outcomes of patients with bacteraemia due to heteroresistant vancomycin-intermediate Staphylococcus aureus and vancomycin-susceptible S. aureus

• Published in: Journal of antimicrobial chemotherapy 2012-08, Vol.67 (8), p.1843-1849
• Main Authors: PARK, Ki-Ho, EUN SIL KIM, LEE, Sang-Oh, CHOI, Sang-Ho, JEONG, Jin-Yong, KIM, Mi-Na, JUN HEE WOO, YANG SOO KIM, HEE SEUNG KIM, PARK, Su-Jin, KYUNG MI BANG, HYUN JUNG PARK, PARK, So-Youn, SONG MI MOON, YONG PIL CHONG, KIM, Sung-Han
• Format: Article
• Language: English
• Subjects: Aged; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteremia; Bacteremia - microbiology; Bacteremia - mortality; Bacteremia - pathology; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Cohort Studies; Comparative studies; Drug resistance; Female; Genotype; Genotype & phenotype; Genotypes; Human bacterial diseases; Humans; Immunosuppressive agents; Infectious diseases; Male; Medical sciences; Methicillin-Resistant Staphylococcus aureus - classification; Methicillin-Resistant Staphylococcus aureus - genetics; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Middle Aged; Minimum inhibitory concentration; Mortality; Pharmacology. Drug treatments; Polymerase chain reaction; Prospective Studies; Rifampin; Staphylococcal Infections - microbiology; Staphylococcal Infections - mortality; Staphylococcal Infections - pathology; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Staphylococcus infections; Survival Analysis; Treatment Outcome; Vancomycin; Vancomycin Resistance; virulence factors
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dks131

We compared the clinical characteristics and outcomes of, and the bacterial genotypes in, patients with bacteraemia due to heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) and vancomycin-susceptible S. aureus (VSSA). A total of 268 consecutive patients with methicillin-resistant S. aureus (MRSA) bacteraemia were prospectively enrolled. All isolates were selected on the first day of bacteraemia and subjected to population analysis profiling for identification of hVISA phenotype and PCR analysis for 41 virulence factors. Of 268 MRSA isolates, 101 (37.7%) were identified as hVISA. Overall mortality was similar in hVISA- and VSSA-infected patients (45/101 versus 65/167; P = 0.36). The following factors were independently associated with the presence of hVISA: a vancomycin MIC ≥2 mg/L by Etest [adjusted OR (aOR), 9.98; 95% CI, 4.22-23.59], rifampicin resistance (aOR, 5.74; 95% CI, 1.35-24.37), prior vancomycin therapy (aOR, 3.04; 95% CI, 1.49-6.17) and use of immunosuppressive therapy (aOR, 2.41; 95% CI, 1.12-5.17). Among patients with hVISA, bacteraemia was more likely to persist for ≥7 days in patients with an initial vancomycin trough