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High vancomycin minimum inhibitory concentration and clinical outcomes in adults with methicillin-resistant

Jesse T Jacob1, Carlos A DiazGranados

  • 1Division of Infectious Diseases, Emory University School of Medicine, Orr Building, Suite 1020, 550 Peachtree Street NE, Atlanta, GA 30308, USA. jtjacob@emory.edu

International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases
|October 24, 2012
PubMed
Abstract

Insights

High vancomycin minimum inhibitory concentration (MIC) in methicillin-resistant Staphylococcus aureus (MRSA) infections is linked to worse patient outcomes. This includes increased treatment failure and higher mortality rates, even with susceptible MIC levels.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Pharmacology

Background:

  • Methicillin-resistant Staphylococcus aureus (MRSA) infections pose significant treatment challenges.
  • Vancomycin is a key antibiotic for MRSA, but rising minimum inhibitory concentrations (MICs) are a concern.
  • Patients with MRSA isolates exhibiting high, yet susceptible, vancomycin MICs may experience poorer clinical outcomes.

Purpose of the Study:

  • To investigate the association between high vancomycin MICs and clinical outcomes in patients with MRSA infections.
  • To compare treatment failure and mortality rates in patients with high versus low vancomycin MICs.

Main Methods:

  • A systematic literature search of PubMed, Cochrane Library, and conference abstracts (2000-2010).
  • Inclusion of studies using broth microdilution (BMD) or Etest for vancomycin MIC determination in MRSA infections.
  • Classification of patients into high MIC (≥1 mg/L by BMD or ≥1.5 mg/L by Etest) and low MIC groups for outcome assessment.

Main Results:

  • Analysis of 14 publications and 6 abstracts, encompassing 2439 patients (1492 high MIC, 947 low MIC).
  • Significantly increased risk of treatment failure (RR 1.40) and mortality (RR 1.42) in the high vancomycin MIC group.
  • Consistent findings in sensitivity analyses, including for patients with bacteremia, despite variable study quality and endpoints.

Conclusions:

  • A high, but susceptible, vancomycin MIC is associated with increased treatment failure and mortality in MRSA infections.
  • These findings highlight the clinical relevance of monitoring vancomycin MICs in MRSA infections.
  • Further research may be warranted to optimize treatment strategies for MRSA with high vancomycin MICs.

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