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Impact of Vancomycin MIC on Treatment Outcomes in Invasive Staphylococcus aureus Infections

Kyoung-Ho Song1, Moonsuk Kim1, Chung Jong Kim1

  • 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.

Antimicrobial Agents and Chemotherapy
|December 14, 2016
PubMed

Insights

High vancomycin MIC (minimum inhibitory concentration) in Staphylococcus aureus infections does not increase 30-day mortality. This study found no link between elevated vancomycin MIC and patient outcomes, regardless of MRSA status.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Pharmacology

Background:

  • Conflicting data exist regarding the association between vancomycin minimum inhibitory concentration (MIC) and treatment outcomes in *Staphylococcus aureus* infections.
  • Invasive *S. aureus* (ISA) infections, defined by isolation from sterile sites, pose significant clinical challenges.
  • Methicillin-resistant *S. aureus* (MRSA) infections often require vancomycin therapy, making vancomycin MIC a critical parameter.

Purpose of the Study:

  • To investigate the relationship between high vancomycin MIC (VAN-MIC) and 30-day all-cause mortality in patients with invasive *S. aureus* infections.
  • To identify risk factors associated with mortality in this patient cohort.
  • To evaluate the clinical utility of VAN-MIC in guiding treatment decisions for ISA infections.

Main Methods:

  • A large cohort study involving 1,027 adult patients with ISA infections across 10 hospitals over a 2-year period.
  • Vancomycin MIC determination using both Etest and broth microdilution (BMD) methods.
  • Analysis of 30-day all-cause mortality rates and associated risk factors, stratified by VAN-MIC levels and methicillin susceptibility.

Main Results:

  • A total of 200 isolates (19.5%) had high VAN-MIC (≥1.5 mg/liter) by Etest, and 87 isolates (8.5%) by BMD.
  • The overall 30-day mortality rate was 27.4%.
  • High VAN-MIC, by either Etest or BMD, was not significantly associated with an increased risk of 30-day all-cause mortality. This finding remained consistent across different MIC methodologies and methicillin susceptibility profiles (MRSA vs. MSSA).

Conclusions:

  • Elevated vancomycin MIC is not independently associated with increased 30-day all-cause mortality in patients with invasive *Staphylococcus aureus* infections.
  • Current clinical practice regarding vancomycin therapy for ISA infections should not be altered based solely on VAN-MIC values.
  • Further research may be needed to identify other factors influencing vancomycin treatment outcomes in *S. aureus* infections.
Keywords:
MICStaphylococcus aureusbacteremiamethicillin resistantmethicillin susceptiblevancomycin

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