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首页> 外文期刊>Infectious Diseases and Therapy >Role of Vancomycin Minimum Inhibitory Concentrations by Modified Population Analysis Profile Method and Clinical Outcomes in High Inoculum Methicillin-Resistant Staphylococcus aureus Infections
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Role of Vancomycin Minimum Inhibitory Concentrations by Modified Population Analysis Profile Method and Clinical Outcomes in High Inoculum Methicillin-Resistant Staphylococcus aureus Infections

机译：改良群体分析概况法和临床结果在耐高耐甲氧西林金黄色葡萄球菌感染中万古霉素最低抑菌浓度的作用

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IntroductionVancomycin remains the standard of care for invasive methicillin-resistant Staphylococcus aureus (MRSA) infections. Treatment failures from heteroresistant vancomycin-intermediate subpopulations (hVISA) are challenging to detect. Minimum inhibitory concentrations (MIC) identified by modified population analysis profile (PAP) is an alternative testing method. The aim of this study was to evaluate the role of PAP MIC on vancomycin failures in two high inoculum infections: MRSA infective endocarditis and pneumonia. MethodsRetrospective, observational study at Detroit Medical Center from 2008 to 2016. Adults ≥?18?years with ≥?1 positive MRSA blood culture from IE or pneumonia source and received ≥?48?h vancomycin were included. The primary outcome was composite failure: MRSA bacteremia ≥?7?days or 30-day all-cause mortality. ResultsA total of 191 patients were included; 47.6% IE and 52.4% pneumonia. About 19% were hVISA isolates, median vancomycin PAP MIC of 3 (2, 3). More than half (54.5%) experienced composite failure with a larger proportion of PAP MIC ≥?4?mg/L in this group (25 vs. 15%, p =?0.086). Patients with IE experienced prolonged bacteremia whereas patients with pneumonia experienced higher 30-day mortality. On logistic regression analysis, age [adjusted odds ratio (aOR), 1.026; 95% confidence interval (CI), 1.005–1.047; p =?0.014] and APACHE II score (aOR 1.039; 95% CI, 1.004–1.076; p =?0.029) independently predicted composite failure. ConclusionVancomycin PAP MIC may be a more relevant predictor of patient outcomes in persistent bacteremic MRSA infections (e.g., IE). This susceptibility method is less applicable in other high inoculum infections with shorter bacteremia durations and higher mortality rates (e.g., pneumonia).
机译：简介万古霉素仍然是耐甲氧西林金黄色葡萄球菌（MRSA）感染的护理标准。难治性万古霉素中间亚群（hVISA）导致的治疗失败具有挑战性。通过修改的种群分析图谱（PAP）识别的最低抑菌浓度（MIC）是另一种测试方法。这项研究的目的是评估PAP MIC在两种高接种物感染（MRSA感染性心内膜炎和肺炎）中万古霉素失败中的作用。方法2008年至2016年在底特律医学中心进行的回顾性观察研究。包括≥18岁的IE或肺炎患者MRSA血培养阳性≥1岁且接受≥48 h h万古霉素的成年人。主要结局为复合衰竭：MRSA菌血症≥7天或30天全因死亡率。结果共纳入191例患者。 IE为47.6％，肺炎为52.4％。 hVISA分离株约占19％，万古霉素PAP MIC中位数为3（2，3）。在这一组中，超过一半（54.5％）经历了复合物衰竭，且PAP MIC≥？4？mg / L的比例更大（25％vs. 15％，p =？0.086）。 IE患者的菌血症时间延长，而肺炎患者的30天死亡率更高。经逻辑回归分析，年龄[调整后的优势比（aOR）为1.026; 95％置信区间（CI），1.005-1.047; p =？0.014]和APACHE II评分（aOR 1.039; 95％CI，1.004–1.076; p =？0.029）独立地预测复合材料破坏。结论万古霉素PAP MIC可能是持久性MRSA细菌感染（例如IE）患者预后的更相关预测指标。这种敏感性方法不太适用于菌血症持续时间较短和死亡率较高的其他高接种量感染（例如肺炎）。

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