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Vancomycin MICs and risk of complicated bacteremia by glycopeptide-susceptible Staphylococcus aureus

Rocío Falcón1, Eva Mateo1, Rosa Oltra2

  • 1Microbiology Service, Fundación INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|February 8, 2019
PubMed

Insights

Vancomycin (VAN) MICs and phagocyte susceptibility did not predict complicated Staphylococcus aureus bacteremia (SAB). However, specific bacterial genes (Sec and Sel) were linked to complicated SAB outcomes.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Genetics

Background:

  • Vancomycin (VAN) minimum inhibitory concentrations (MICs) at the upper susceptible range for Staphylococcus aureus (S. aureus) and isolate genetic background have been linked to poor outcomes in S. aureus bloodstream infections (SAB).
  • Accurate prediction of complicated SAB requires understanding the interplay between VAN susceptibility, bacterial virulence factors, and host immune response.

Purpose of the Study:

  • To assess the impact of VAN MICs (using a refined broth microdilution method), S. aureus susceptibility to phagocyte killing (as a marker for cell wall thickness), and S. aureus genetic composition on the development of complicated SAB.
  • To identify specific genetic markers associated with complicated SAB.

Main Methods:

  • Retrospective, observational single-center cohort study of 148 patients with SAB (113 methicillin-susceptible S. aureus [MSSA], 35 methicillin-resistant S. aureus [MRSA]).
  • S. aureus isolates were genotyped using DNA microarray.
  • VAN MICs were determined by broth microdilution (BMD) and Etest; phagocyte killing susceptibility was assessed.

Main Results:

  • VAN MICs and phagocyte killing susceptibility were comparable between complicated and uncomplicated SAB isolates, regardless of the testing method (BMD: P=0.19; Etest: P=0.94; phagocytosis: P=0.5).
  • The S. aureus DNA array identified Sec and Sel genes as differentially present, being overrepresented in isolates from complicated SAB cases.
  • Presence of Sec and Sel genes was independently associated with complicated SAB in multivariate analysis.

Conclusions:

  • Neither VAN MICs nor phagocyte killing susceptibility effectively predicted complicated SAB in this cohort.
  • The bacterial genes Sec and Sel are potential independent predictors of complicated S. aureus bacteremia.
  • Further research into the role of Sec and Sel in S. aureus pathogenesis is warranted.
Keywords:
Broth microdilution methodComplicated bacteremiaMinimum inhibitory concentration (MIC)Staphylococcus aureusVancomycin

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