Risk factors for mortality in patients with persistent methicillin-resistant Staphylococcus aureus bacteraemia in a tertiary care hospital in Taiwan

Lin, Sheng-Hsiang; Liao, Wan-Hsiu; Lai, Chih‐Cheng; Liao, Chun-Hsing; Tan, Che-Kim; Chen, Ming-Fong; Huang, Yu-Tsung; Hsueh, Po-Ren

doi:10.1093/jac/dkq188

Cited by 41 publications

(37 citation statements)

References 27 publications

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“…Based on the Charlson comorbidity index or Pitt's bacteremia score, the clinical severity of the infections of the patients in our study was comparable to that of health care-associated and community-acquired MRSA infections (14,26). In addition, 4 risk factors for clinical failure of HA-MRSA bacteremia, namely, Pitt's bacteremia score, acute renal injury, duration of fever, and bacteremia, were not different from those reported previously (26)(27)(28)(29).…”

Section: Discussionsupporting

confidence: 70%

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Multicenter Prospective Observational Study of the Comparative Efficacy and Safety of Vancomycin versus Teicoplanin in Patients with Health Care-Associated Methicillin-Resistant Staphylococcus aureus Bacteremia

Yoon

Park²,

Kim

et al. 2014

Antimicrob Agents Chemother

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pThe purpose of this study was to compare the clinical efficacy and safety of vancomycin to those of teicoplanin for the treatment of adult patients with health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) bacteremia. A multicenter observational study was prospectively conducted in 15 teaching hospitals in Korea between February 2010 and July 2011. Adult patients (>18 years old) with HA-MRSA bacteremia who were initially treated with vancomycin (VAN) (n ‫؍‬ 134) or teicoplanin (TEC) (n ‫؍‬ 56) were enrolled. Clinical and microbiological responses and drug-related adverse events were compared between the two treatment groups using univariate and multivariate logistic regression analyses. The vancomycin and teicoplanin MICs were determined by Etest. The MRSA-related mortality, duration of fever, and duration of MRSA bacteremia in the treatment groups were not significantly different. There was no significant difference in the occurrence of drug-related adverse events. Among the 190 MRSA isolates, the VAN MICs ranged from 0.5 to 2 g/ml (MIC 50 and MIC 90 , 1.5 g/ml), and the TEC MIC ranged from 0.5 to 8 g/ml (MIC 50 , 3 g/ml; MIC 90 , 6 g/ml). In multivariate analyses, the antibiotic type (vancomycin or teicoplanin) was not associated with treatment outcomes. This study indicates that teicoplanin is an effective and safe alternative to vancomycin for the treatment of HA-MRSA bacteremia.

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Section: Discussionsupporting

confidence: 70%

“…However, the appropriateness of this alternative therapy needs to be evaluated in prospective randomized controlled trials. Antibiotics such as linezolid or daptomycin as promising salvage agents or a novel strategy of combined antibiotic treatment should be considered for better treatment outcomes of HA-MRSA bacteremia (27,35).…”

Section: Discussionmentioning

confidence: 99%

Multicenter Prospective Observational Study of the Comparative Efficacy and Safety of Vancomycin versus Teicoplanin in Patients with Health Care-Associated Methicillin-Resistant Staphylococcus aureus Bacteremia

Yoon

Park²,

Kim

et al. 2014

Antimicrob Agents Chemother

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“…These comorbidities include the presence of alcoholism (131), immunosuppression (131), cirrhosis (133,134,138,140), congestive cardiac failure (171), malignancy (33,77,133,134,140,308,309), chronic renal failure requiring hemodialysis (77,131,134,184), and the presence of multiple comorbidities (14).…”

Section: Presence Of Comorbiditiesmentioning

confidence: 99%

“…These complicated infections in turn lead to poorer outcomes (170,171). Even in the absence of metastatic complications, persistence per se portends a worse outcome, with infection-related mortality rates being higher for patients with MRSA-B persistence (Ͼ3 days) than for nonpersistent episodes (45.2% and 9.4%, respectively; P ϭ 0.002) (323).…”

Section: Persistent Bacteremiamentioning

confidence: 99%

Predictors of Mortality in Staphylococcus aureus Bacteremia

et al. 2012

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SUMMARY Staphylococcus aureus bacteremia (SAB) is an important infection with an incidence rate ranging from 20 to 50 cases/100,000 population per year. Between 10% and 30% of these patients will die from SAB. Comparatively, this accounts for a greater number of deaths than for AIDS, tuberculosis, and viral hepatitis combined. Multiple factors influence outcomes for SAB patients. The most consistent predictor of mortality is age, with older patients being twice as likely to die. Except for the presence of comorbidities, the impacts of other host factors, including gender, ethnicity, socioeconomic status, and immune status, are unclear. Pathogen-host interactions, especially the presence of shock and the source of SAB, are strong predictors of outcomes. Although antibiotic resistance may be associated with increased mortality, questions remain as to whether this reflects pathogen-specific factors or poorer responses to antibiotic therapy, namely, vancomycin. Optimal management relies on starting appropriate antibiotics in a timely fashion, resulting in improved outcomes for certain patient subgroups. The roles of surgery and infectious disease consultations require further study. Although the rate of mortality from SAB is declining, it remains high. Future international collaborative studies are required to tease out the relative contributions of various factors to mortality, which would enable the optimization of SAB management and patient outcomes.

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“…The mortality rate for patients with persistent SAB (lasting more than seven days) has been reported to be significantly higher than that for patients with non-persistent SAB (12). The longer the SAB persists, the poorer the outcome (13,14).…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Persistent MRSA Bacteremia using High-dose Daptomycin Combined with Rifampicin

et al. 2014

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We herein report a case of persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia that was successfully treated with combination therapy consisting of high-dose daptomycin (DAP, 10 mg/kg) and rifampicin. The patient's condition was complicated with multiple infectious foci, including an iliopsoas abscess and epidural abscess, as well as discitis and spondylitis at the cervical, thoracic and lumbar levels. Monotherapy treatments with vancomycin, linezolid and usual-dose DAP were all ineffective. It has been shown that usual-dose DAP administration may result in the emergence of a resistant strain and treatment failure. We would like to emphasize the importance of high-dose DAP therapy for MRSA bacteremia, a condition with a potentially high mortality rate.

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Risk factors for mortality in patients with persistent methicillin-resistant Staphylococcus aureus bacteraemia in a tertiary care hospital in Taiwan

Abstract: Congestive heart failure and metastatic infections were predictors of mortality. Isolates with decreased susceptibility to vancomycin that emerged during persistent MRSA bacteraemia were associated with mortality. Aggressive attempts to completely eradicate foci should be encouraged.

Cited by 41 publications

References 27 publications

Multicenter Prospective Observational Study of the Comparative Efficacy and Safety of Vancomycin versus Teicoplanin in Patients with Health Care-Associated Methicillin-Resistant Staphylococcus aureus Bacteremia

Multicenter Prospective Observational Study of the Comparative Efficacy and Safety of Vancomycin versus Teicoplanin in Patients with Health Care-Associated Methicillin-Resistant Staphylococcus aureus Bacteremia

Predictors of Mortality in Staphylococcus aureus Bacteremia

Successful Treatment of Persistent MRSA Bacteremia using High-dose Daptomycin Combined with Rifampicin

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