Factors Influencing Time to Vancomycin‐Induced Clearance of Nonendocarditis Methicillin‐ResistantStaphylococcus aureusBacteremia: Role of Platelet Microbicidal Protein Killing andagrGenotypes
Open Access
- 15 January 2010
- journal article
- Published by Oxford University Press (OUP) in The Journal of Infectious Diseases
- Vol. 201 (2), 233-240
- https://doi.org/10.1086/649429
Abstract
Background. Vancomycin susceptibility, the accessory gene global regulator (agr) genotype and function, staphylococcal cassette chromosome (SCC) mec type, and susceptibility to cationic thrombin-induced platelet microbicidal protein 1 (tPMP-1) have been individually predictive of duration of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. This investigation evaluated the interrelationship of these factors with time to clearance of MRSA bacteremia during vancomycin therapy in patients without endocarditis. Methods. Vancomycin minimum inhibitory concentration and in vitro killing, agr function (δ-hemolysin activity), agr group, SCCmec type, and survival in tPMP-1 killing assays were determined for 29 MRSA bacteremia isolates. Results. Increased resistance to tPMP-1 killing was observed with agr group III MRSA (P = .025) and MRSA with reduced or absent agr function (P = .023). The median time to clearance of MRSA bacteremia was earlier for agr group III (3 days) versus group I (10.5 days) or II (15 days) (P = .001). In multivariate analysis, agr group II, reduced tPMP-1 killing in vitro, and prior vancomycin exposure were significant independent predictors of longer MRSA bacteremia duration. Conclusions. Specific genotypic, phenotypic, and clinical parameters appear to correlate with persistent MRSA bacteremia. The interrelationship of these and other factors probably contributes to vancomycin-mediated clearance of MRSA bacteremia.Keywords
This publication has 27 references indexed in Scilit:
- Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases PharmacistsAmerican Journal of Health-System Pharmacy, 2009
- Comparison of method-specific vancomycin minimum inhibitory concentration values and their predictability for treatment outcome of meticillin-resistant Staphylococcus aureus (MRSA) infectionsInternational Journal of Antimicrobial Agents, 2008
- Microbiological and Genotypic Analysis of Methicillin-Resistant Staphylococcus aureus BacteremiaAntimicrobial Agents and Chemotherapy, 2008
- Relationship between Vancomycin MIC and Failure among Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia Treated with VancomycinAntimicrobial Agents and Chemotherapy, 2008
- Predictors of high vancomycin MIC values among patients with methicillin-resistant Staphylococcus aureus bacteraemiaJournal of Antimicrobial Chemotherapy, 2008
- Influence of Vancomycin Minimum Inhibitory Concentration on the Treatment of Methicillin-Resistant Staphylococcus aureus BacteremiaClinical Infectious Diseases, 2008
- Microbiological effects of prior vancomycin use in patients with methicillin-resistant Staphylococcus aureus bacteraemiaJournal of Antimicrobial Chemotherapy, 2007
- Vancomycin In Vitro Bactericidal Activity and Its Relationship to Efficacy in Clearance of Methicillin-Resistant Staphylococcus aureus BacteremiaAntimicrobial Agents and Chemotherapy, 2007
- Evaluation of Accessory Gene Regulator ( agr ) Group and Function in the Proclivity towards Vancomycin Intermediate Resistance in Staphylococcus aureusAntimicrobial Agents and Chemotherapy, 2007
- High-Dose Vancomycin Therapy for Methicillin-Resistant Staphylococcus aureus InfectionsArchives of Internal Medicine, 2006