Vancomycin therapy of oxacillin-resistant Staphylococcus aureus infections

Infections caused by oxacillin-resistant staphylococci were studied in 27 patients, who received vancomycin therapy as soon as the resistance of the pathogenic staphylococcal strain to oxacillin was documented. Therapy with vancomycin was usually started not later than 48 h after the onset of empiric therapy with oxacillin or cefamandole. In spite of high bactericidal activity in the serum of the patients receiving vancomycin, only 16 (59%) out of 27 patients responded to the treatment. Favourable clinical responses were usually associated with bacteriological cure, but super-infection by Gram-negative bacillary rods was a common complication in this series; it occurred in eight (30%) of the 27 patients studied. The overall death rate was 33% (9/27); death was associated in six patients with persisting staphylococcal infection and in three patients with Gram-negative bacillary superinfection of the bronchopulmonary tract, with or without persistent staphylococcal infection.