Coagulase-negative staphylococcal bloodstream infections: Does vancomycin remain appropriate empiric therapy?. Issue 1 (July 2015)

• Record Type: Journal Article
• Authors: Valencia-Rey, Paula; Weinberg, Janice; Miller, Nancy S.; Barlam, Tamar F.
• Is Part Of: Journal of infection. Volume 71:Issue 1(2015)
• Page Start: 53
• Page End: 60
• Publication Date: 2015-07
• Subjects: Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2015.02.007
• Languages: English
• ISSNs: 0163-4453

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Summary</title> <sec> <title id="sectitle0015">Objectives</title> <p id="abspara0010">It is unknown if vancomycin minimal inhibitory concentrations (MICs) have increased in coagulase-negative staphylococci (CoNS) or whether vancomycin remains appropriate empiric therapy.</p> </sec> <sec> <title id="sectitle0020">Methods</title> <p id="abspara0015">We performed a retrospective study at a single tertiary care center over 8 years. Adult inpatients with ≥2 positive blood cultures for CoNS within a 48-h period were eligible. Susceptibilities were performed by automated broth based-microdilution. Changes in antimicrobial susceptibility were analyzed using logistic regression. The clinical characteristics and outcomes of patients with bloodstream infections (BSI) were compared by MIC.</p> </sec> <sec> <title id="sectitle0025">Results</title> <p id="abspara0020">Of 308 episodes of possible CoNS bacteremia, the vancomycin MIC was ≤1 μg/mL in 80 (26%) isolates, 2 μg/mL in 223 (72.4%) isolates and 4 μg/mL in 5 (1.6%) isolates. No isolates were resistant. We observed an 11-fold increased chance of having an isolate with a vancomycin MIC ≤1 μg/mL in 2009–2011 compared with 2004–2008 (OR 10.8, 95% CI 6.0–19.5, p < 0.05). In 152 patients with BSI, the median days of bacteremia, hospital mortality and readmissions at 30 days were similar in BSI caused by isolates with high vancomycin MICs (2–4 μg/mL) and low vancomycin MICs (≤1 μg/mL).</p> </sec> <sec> <title id="sectitle0030">Conclusions</title> <p id="abspara0025">We conclude vancomycin is still appropriate empiric therapy for CoNS BSIs. CoNS vancomycin MICs decreased over the study period despite widespread use of vancomycin.</p> </sec> </abstract>