The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Predictors and clinical outcomes of persistent methicillin-resistant Staphylococcus aureus bacteremia: a prospective observational study

  • Ok, Hea Sung (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Hyoun Soo (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Man Je (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Ki Hoon (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Byeong Ki (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Wi, Yu Mi (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, June Myung (Department of Medicine, Yonsei University College of Medicine)
  • Received : 2011.09.05
  • Accepted : 2012.08.21
  • Published : 2013.11.01
⟨ Previous Next ⟩

Abstract

Background/Aims: The high mortality attributable to persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in spite of glycopeptide treatment has heightened the need for early detection and intervention with alternative agents. The purpose of this study was to determine the clinical characteristics of and risk factors for persistent MRSA bacteremia. Methods: All first episodes of significant MRSA bacteremia at a 710-bed academic medical center from November 2009 through August 2010 were recorded. Blood cultures were conducted at 3 days and every 2 to 3 days thereafter until clearance. Clinical characteristics and outcomes were compared between persistent MRSA bacteremia (${\geq}$ 7 days) and nonpersistent MRSA bacteremia (${\leq}$ 3 days). Results: Of 79 patients with MRSA bacteremia during the study period, 31 (39.2%) had persistent MRSA bacteremia. The persistent MRSA bacteremia group had significantly higher 30-day mortality than the nonpersistent MRSA bacteremia group (58.1% vs. 16.7%, p < 0.001). Multivariate analysis indicated that metastatic infection at presentation (odds ratio [OR], 14.57; 95% confidence interval [CI], 3.52 to 60.34; p < 0.001) and delayed catheter removal in catheter-related infection (OR, 3.80; 95% CI, 1.04 to 13.88; p = 0.004) were independent predictors of persistent MRSA bacteremia. Patients with a time to blood culture positivity (TTP) of < 11.8 hours were at increased risk of persistent MRSA bacteremia (29.0% vs. 8.3%, p = 0.029). Conclusions: High mortality in patients with persistent MRSA bacteremia was noted. Early detection of metastatic infection and early removal of infected intravascular catheters should be considered to reduce the risk of persistent MRSA bacteremia. Further studies are needed to evaluate the role of TTP for predicting persistent MRSA bacteremia.

Keywords

References

  1. Soriano A, Martinez JA, Mensa J, et al. Pathogenic signif icance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis 2000;30:368-373. https://doi.org/10.1086/313650
  2. Blot SI, Vandewoude KH, Hoste EA, Colardyn FA. Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002;162:2229-2235. https://doi.org/10.1001/archinte.162.19.2229
  3. Jensen AG, Wachmann CH, Espersen F, Scheibel J, Skinhoj P, Frimodt-Moller N. Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases. Arch Intern Med 2002;162:25-32. https://doi.org/10.1001/archinte.162.1.25
  4. Styers D, Sheehan DJ, Hogan P, Sahm DF. Laboratory-based surveillance of current antimicrobial resistance patterns and trends among Staphylococcus aureus: 2005 status in the United States. Ann Clin Microbiol Antimicrob 2006;5:2. https://doi.org/10.1186/1476-0711-5-2
  5. Hawkins C, Huang J, Jin N, Noskin GA, Zembower TR, Bolon M. Persistent Staphylococcus aureus bacteremia: an analysis of risk factors and outcomes. Arch Intern Med 2007;167:1861-1867. https://doi.org/10.1001/archinte.167.17.1861
  6. Khatib R, Johnson LB, Sharma M, Fakih MG, Ganga R, Riederer K. Persistent Staphylococcus aureus bacteremia: incidence and outcome trends over time. Scand J Infect Dis 2009;41:4-9. https://doi.org/10.1080/00365540802441711
  7. Yoon YK, Kim JY, Park DW, Sohn JW, Kim MJ. Predictors of persistent methicillin-resistant Staphylococcus aureus bacteraemia in patients treated with vancomycin. J Antimicrob Chemother 2010;65:1015-1018. https://doi.org/10.1093/jac/dkq050
  8. Neuner EA, Casabar E, Reichley R, McKinnon PS. Clinical, microbiologic, and genetic determinants of persistent methicillin-resistant Staphylococcus aureus bacteremia. Diagn Microbiol Infect Dis 2010;67:228-233. https://doi.org/10.1016/j.diagmicrobio.2010.02.026
  9. Fowler VG Jr, Sakoulas G, McIntyre LM, et al. Persistent bacteremia due to methicillin-resistant Staphylococcus aureus infection is associated with agr dysfunction and low-level in vitro resistance to thrombin-induced platelet microbicidal protein. J Infect Dis 2004;190:1140-1149. https://doi.org/10.1086/423145
  10. Moise PA, Sakoulas G, Forrest A, Schentag JJ. Vancomycin in vitro bactericidal activity and its relationship to efficacy in clearance of methicillin-resistant Staphylococcus aureus bacteremia. Antimicrob Agents Chemother 2007;51:2582-2586. https://doi.org/10.1128/AAC.00939-06
  11. Lin SH, Liao WH, Lai CC, et al. Risk factors for mortality in patients with persistent methicillin-resistant Staphylococcus aureus bacteraemia in a tertiary care hospital in Taiwan. J Antimicrob Chemother 2010;65:1792-1798. https://doi.org/10.1093/jac/dkq188
  12. Kim JS, Kim HS, Song W, Cho HC, Lee KM, Kim EC. Antimicrobial resistance profiles of Staphylococcus aureus isolated in 13 Korean hospitals. Korean J Lab Med 2004;24:223-229.
  13. Kang CI, Song JH, Chung DR, et al. Clinical impact of methicillin resistance on outcome of patients with Staphylococcus aureus infection: a stratified analysis according to underlying diseases and sites of infection in a large prospective cohort. J Infect 2010;61:299-306. https://doi.org/10.1016/j.jinf.2010.07.011
  14. Libman H, Arbeit RD. Complications associated with Staphylococcus aureus bacteremia. Arch Intern Med 1984;144:541-545. https://doi.org/10.1001/archinte.1984.00350150137033
  15. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633-638. https://doi.org/10.1086/313753
  16. Sakoulas G, Moise-Broder PA, Schentag J, Forrest A, Moellering RC Jr, Eliopoulos GM. Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol 2004;42:2398-2402. https://doi.org/10.1128/JCM.42.6.2398-2402.2004
  17. Soriano A, Marco F, Martinez JA, et al. Inf luence of vancomycin minimum inhibitory concentration on the treatment of methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2008;46:193-200. https://doi.org/10.1086/524667
  18. Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med 2006;166:2138-2144. https://doi.org/10.1001/archinte.166.19.2138
  19. Fowler VG Jr, Justice A, Moore C, et al. Risk factors for hematogenous complications of intravascular catheter-associated Staphylococcus aureus bacteremia. Clin Infect Dis 2005;40:695-703. https://doi.org/10.1086/427806
  20. Khatib R, Riederer K, Saeed S, et al. Time to positivity in Staphylococcus aureus bacteremia: possible correlation with the source and outcome of infection. Clin Infect Dis 2005;41:594-598. https://doi.org/10.1086/432472
  21. Blot F, Schmidt E, Nitenberg G, et al. Earlier positivity of central-venous- versus peripheral-blood cultures is highly predictive of catheter-related sepsis. J Clin Microbiol 1998;36:105-109.
  22. Rogers MS, Oppenheim BA. The use of continuous monitoring blood culture systems in the diagnosis of catheter related sepsis. J Clin Pathol 1998;51:635-637. https://doi.org/10.1136/jcp.51.8.635
  23. Marra AR, Edmond MB, Forbes BA, Wenzel RP, Bearman GM. Time to blood culture positivity as a predictor of clinical outcome of Staphylococcus aureus bloodstream infection. J Clin Microbiol 2006;44:1342-1346. https://doi.org/10.1128/JCM.44.4.1342-1346.2006
  24. LaPlante KL, Rybak MJ. Impact of high-inoculum Staphylococcus aureus on the activities of nafcillin, vancomycin, linezolid, and daptomycin, alone and in combination with gentamicin, in an in vitro pharmacodynamic model. Antimicrob Agents Chemother 2004;48:4665-4672. https://doi.org/10.1128/AAC.48.12.4665-4672.2004
  25. Rybak MJ, Lomaestro BM, Rotschafer JC, et al. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis 2009;49:325-327. https://doi.org/10.1086/600877
  26. Mason EO, Lamberth LB, Hammerman WA, Hulten KG, Versalovic J, Kaplan SL. Vancomycin MICs for Staphylococcus aureus vary by detection method and have subtly increased in a pediatric population since 2005. J Clin Microbiol 2009;47:1628-1630. https://doi.org/10.1128/JCM.00407-09
  27. Price J, Atkinson S, Llewelyn M, Paul J. Paradoxical relationship between the clinical outcome of Staphylococcus aureus bacteremia and the minimum inhibitory concentration of vancomycin. Clin Infect Dis 2009;48:997-998. https://doi.org/10.1086/597359
  28. Khosrovaneh A, Riederer K, Saeed S, et al. Frequency of reduced vancomycin susceptibility and heterogeneous subpopulation in persistent or recurrent methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2004;38:1328-1330. https://doi.org/10.1086/383036
  29. van Hal SJ, Barbagiannakos T, Jones M, et al. Methicillin-resistant Staphylococcus aureus vancomycin susceptibility testing: methodology correlations, temporal trends and clonal patterns. J Antimicrob Chemother 2011;66:2284-2287. https://doi.org/10.1093/jac/dkr280
  30. Charles PG, Ward PB, Johnson PD, Howden BP, Grayson ML. Clinical features associated with bacteremia due to heterogeneous vancomycin-intermediate Staphylococcus aureus. Clin Infect Dis 2004;38:448-451. https://doi.org/10.1086/381093
  31. Musta AC, Riederer K, Shemes S, et al. Vancomycin MIC plus heteroresistance and outcome of methicillin-resistant Staphylococcus aureus bacteremia: trends over 11 years. J Clin Microbiol 2009;47:1640-1644. https://doi.org/10.1128/JCM.02135-08
  32. Lodise TP, Graves J, Evans A, et al. Relationship between vancomycin MIC and failure among patients with methicillin-resistant Staphylococcus aureus bacteremia treated with vancomycin. Antimicrob Agents Chemother 2008;52:3315-3320. https://doi.org/10.1128/AAC.00113-08

Cited by

  1. Persistent methicillin-resistant Staphylococcus aureus bacteremia: do we need a new therapeutic strategy? vol.28, pp.6, 2013, https://doi.org/10.3904/kjim.2013.28.6.657
  2. Avoiding the Perfect Storm: The Biologic and Clinical Case for Reevaluating the 7-Day Expectation for Methicillin-Resistant Staphylococcus aureus Bacteremia Before Switching Therapy vol.59, pp.10, 2013, https://doi.org/10.1093/cid/ciu583
  3. The safety and efficacy of high versus low vancomycin trough levels in the treatment of patients with infections caused by methicillin-resistant Staphylococcus aureus : a meta-analysis vol.9, pp.None, 2013, https://doi.org/10.1186/s13104-016-2252-7
  4. Septic Thrombophlebitis with Persistent Methicillin-Resistant Staphylococcus Aureus Bacteremia and de Novo Resistance to Vancomycin and Daptomycin vol.9, pp.2, 2013, https://doi.org/10.4081/idr.2017.7008
  5. Daptomycin and combination daptomycin-ceftaroline as salvage therapy for persistent methicillin-resistant Staphylococcus aureus bacteremia vol.50, pp.8, 2013, https://doi.org/10.1080/23744235.2018.1448110
  6. Value of Time to Positivity of Blood Culture in Children with Bloodstream Infections vol.2019, pp.None, 2013, https://doi.org/10.1155/2019/5975837
  7. Prognostic Power of Pathogen Cell-Free DNA in Staphylococcus aureus Bacteremia vol.6, pp.4, 2013, https://doi.org/10.1093/ofid/ofz126
  8. Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes vol.70, pp.4, 2013, https://doi.org/10.1093/cid/ciz257
  9. Glycopeptide Hypersensitivity and Adverse Reactions vol.8, pp.2, 2013, https://doi.org/10.3390/pharmacy8020070