A survey of attitudes towards methicillin-resistant Staphylococcus aureus bacteraemias amongst United Kingdom microbiologists

Hussain, Abid; Alleyne, Susan; Jenkins, David R.

doi:10.1093/jac/dkp456

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…With the data from this current study, vancomycin as a form of treatment would work in all cases of MRSA investigated in this study. A recent survey examined the antibiotics used in the treatment of MRSA infection in the UK, the findings of this work showed that main treatment consisted of vancomycin singly or in combination [21]. Whilst resistance to this antibiotic remains rare cases have been reported [8,9,11] and therefore increased application may potentially drive the future development of vancomycin resistant strains.…”

Section: Resultsmentioning

confidence: 99%

The need for continued monitoring of antibiotic resistance patterns in clinical isolates of Staphylococcus aureus from London and Malta

Gould

Cuschieri

Rollason

et al. 2010

Ann Clin Microbiol Antimicrob

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BackgroundAntibiotic resistance is an increasing problem in isolates of Staphylococcus aureus (S. aureus) worldwide. In 2001 The National Health Service in the UK introduced a mandatory bacteraemia surveillance scheme for the reporting of S. aureus and methicillin-resistant S. aureus (MRSA). This surveillance initiative reports on the percentage of isolates that are methicillin resistant. However, resistance to other antibiotics is not currently reported and therefore the scale of emerging resistance is currently unclear in the UK. In this study, multiple antibiotic resistance (MAR) profiles against fourteen antimicrobial drugs were investigated for 705 isolates of S. aureus collected from two European study sites in the UK (London) and Malta.ResultsAll isolates were susceptible to linezolid, teicoplanin and vancomycin. Multiple antibiotic resistance profiles from both countries were determined, a total of forty-two and forty-five profiles were seen in the UK cohort (MRSA and MSSA respectively) and comparatively, sixty-two and fifty-two profiles were shown in the Maltese group. The largest MAR profile contained six antibiotics (penicillin G, methicillin, erythromycin, ciprofloxacin, clindamycin and clarithromycin) and was observed in the MRSA isolates in both the UK and Maltese cohorts.ConclusionThe data presented here suggests that the monitoring of changing resistance profiles locally in maintaining treatment efficacy to resistant pathogens.

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Section: Resultsmentioning

confidence: 99%

The need for continued monitoring of antibiotic resistance patterns in clinical isolates of Staphylococcus aureus from London and Malta

Gould

Cuschieri

Rollason

et al. 2010

Ann Clin Microbiol Antimicrob

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“…However, use of the MIC test to direct therapy is variable. A recent survey of UK microbiologists regarding the management of S. aureus bacteraemia found that only one-third routinely monitor MICs [7]. Empirically, vancomycin is presently recommended for initial treatment of suspected severe S. aureus infections in healthcare settings with an increased incidence of MRSA or when other risk factors for MRSA infections are present [6].…”

Section: Vancomycinmentioning

confidence: 99%

Management of serious meticillin-resistant Staphylococcus aureus infections: what are the limits?

Gould

Cauda

Esposito

et al. 2011

International Journal of Antimicrobial Agents

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Severe (life-threatening) meticillin-resistant Staphylococcus aureus (MRSA) infection continues to be treated with vancomycin despite accumulating evidence of poor outcome, increasing resistance and unachievable pharmacokinetic/pharmacodynamic (PK/PD) targets. The minimum inhibitory concentration (MIC) susceptibility breakpoint for vancomycin was recently reduced to 2 mg/L. Whilst the great majority of clinical isolates are thus still classified as susceptible, the available clinical evidence argues for a method-dependent breakpoint of 0.5 mg/L (broth dilution) or 1.0 mg/L (Etest), which would classify many strains as resistant, or at best intermediate. However, automated susceptibility testing systems are not currently capable of performing accurately at this low level, and such low breakpoints are unsatisfactory because the poor reproducibility of tests (plus or minus one doubling dilution) results in a critical non-reproducibility around the modal MIC of 1 mg/L described in most published data. Therefore, vancomycin should be used with caution in severe (life-threatening) staphylococcal disease and the MIC should always be reported by method. Daptomycin is generally preferred for bacteraemia/endocarditis and linezolid for pneumonia. Better outcome data for vancomycin, based on achievable PK/PD targets and using robust MIC tests, are urgently required.

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“…Much current practice is therefore based on clinical experience and observational studies. Recent surveys of European and US physicians have revealed diverse opinions concerning optimal SAB management[12], [13], [14] and there is some evidence of substantial practice variation within these regions[15], [16].…”

Section: Introductionmentioning

confidence: 99%

The Management of Staphylococcus aureus Bacteremia in the United Kingdom and Vietnam: A Multi-Centre Evaluation

Thwaites

2010

PLoS ONE

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Background Staphylococcus aureus bacteremia is a common and serious infection worldwide and although treatment guidelines exist, there is little consensus on optimal management. In this study we assessed the variation in management and adherence to treatment guidelines of S. aureus bacteremia.Methodology/Principal FindingsWe prospectively recorded baseline clinical characteristics, management, and in-hospital outcome of all adults with S. aureus bacteremia treated consecutively over one year in eight centres in the United Kingdom, three in Vietnam and one in Nepal. 630 adults were treated for S. aureus bacteremia: 549 in the UK (21% methicillin-resistant), 80 in Vietnam (19% methicillin-resistant) and 1 in Nepal. In the UK, 41% had a removable infection focus (50% intravenous catheter-related), compared to 12% in Vietnam. Significantly (p<0.001) higher proportions of UK than Vietnamese patients had an echocardiogram (50% versus 28%), received more than 14 days antibiotic therapy (84% versus 44%), and received >50% of treatment with oral antibiotics alone (25% versus 4%). UK centres varied significantly (p<0.01) in the proportions given oral treatment alone for >50% of treatment (range 12–40%), in those treated for longer than 28 days (range 13–54%), and in those given combination therapy (range 14–94%). 24% died during admission: older age, time in hospital before bacteremia, and an unidentified infection focus were independent predictors of in-hospital death (p<0.001).Conclusions/SignificanceThe management of S. aureus bacteremia varies widely between the UK and Vietnam and between centres in the UK with little adherence to published guidelines. Controlled trials defining optimal therapy are urgently required.

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A survey of attitudes towards methicillin-resistant Staphylococcus aureus bacteraemias amongst United Kingdom microbiologists

Abstract: Vancomycin is the mainstay therapy for MRSA BSIs, even when MICs are not measured or raised, despite evidence of high failure rates. The use of newer agents frequently does not follow European or US licensed indications, may be inappropriate and may result in avoidable deaths.

Cited by 7 publications

References 10 publications

The need for continued monitoring of antibiotic resistance patterns in clinical isolates of Staphylococcus aureus from London and Malta

The need for continued monitoring of antibiotic resistance patterns in clinical isolates of Staphylococcus aureus from London and Malta

Management of serious meticillin-resistant Staphylococcus aureus infections: what are the limits?

The Management of Staphylococcus aureus Bacteremia in the United Kingdom and Vietnam: A Multi-Centre Evaluation

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