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Treatment outcomes for serious infections caused by methicillin-resistant Staphylococcus aureus with reduced
Benjamin P Howden1, Peter B Ward, Patrick G P Charles
1Department of Infectious Diseases, Austin Hospital, Heidelberg, Victoria, Australia. Benjamin.Howden@austin.org.au
Abstract:
Although infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility (SA-RVS) have been reported from a number of countries, including Australia, the optimal therapy is unknown. We reviewed the clinical features, therapy, and outcome of 25 patients with serious infections due to SA-RVS in Australia and New Zealand. Eight patients had endocarditis, 9 had bacteremia associated with deep-seated infection, 6 had osteomyelitis or septic arthritis, and 2 had empyema. All patients had received vancomycin before the isolation of SA-RVS, and glycopeptide treatment had failed for 19 patients (76%). Twenty-one patients subsequently received active treatment, which was effective for 16 patients (76%). Eighteen patients received linezolid, which was effective in 14 (78%), including 4 patients with endocarditis. Twelve patients received a combination of rifampicin and fusidic acid. Surgical intervention was required for 15 patients (60%). Antibiotic therapy, especially linezolid with or without rifampicin and fusidic acid, in conjunction with surgical debulking is effective therapy for the majority of patients with serious infections (including endocarditis) caused by SA-RVS.
Insights
Treatment for serious methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility (SA-RVS) infections remains unclear. Linezolid, often combined with rifampicin and fusidic acid, alongside surgery, shows effectiveness in treating these challenging SA-RVS infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility (SA-RVS) presents a growing clinical challenge.
- Optimal therapeutic strategies for SA-RVS infections are not well-established.
- Previous vancomycin treatment failed in a significant proportion of patients.
Purpose of the Study:
- To review the clinical features, treatment, and outcomes of patients with serious SA-RVS infections.
- To evaluate the effectiveness of various antibiotic regimens and surgical interventions.
- To identify optimal therapeutic approaches for SA-RVS infections.
Main Methods:
- Retrospective review of 25 patients with serious SA-RVS infections in Australia and New Zealand.
- Analysis of clinical data, including infection types, prior treatments, and outcomes.
- Assessment of antibiotic efficacy, focusing on linezolid and combination therapies, and the role of surgery.
Main Results:
- Common infections included endocarditis, bacteremia, osteomyelitis, and empyema.
- Glycopeptide treatment failure occurred in 76% of patients.
- Active treatment was effective in 76% of patients; linezolid was effective in 78%, including endocarditis cases.
- Surgical intervention was required for 60% of patients.
Conclusions:
- Antibiotic therapy, particularly linezolid with or without rifampicin and fusidic acid, is effective for SA-RVS infections.
- Surgical debulking is a crucial component of successful treatment.
- Combined antibiotic and surgical approaches offer effective management for serious SA-RVS infections, including endocarditis.
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