Daptomycin Versus Vancomycin for Bloodstream Infections Due to Methicillin-Resistant Staphylococcus aureus With a High Vancomycin Minimum Inhibitory Concentration: A Case-Control Study
Background. Reports have found a link between vancomycin treatment failure in methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs) and higher vancomycin minimum inhibitory concentrations (MICs), despite MICs being below the susceptibility breakpoint of 2 µg/mL. Consensus...
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| Published in | Clinical infectious diseases Vol. 54; no. 1; pp. 51 - 58 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford
Oxford University Press
01.01.2012
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Background. Reports have found a link between vancomycin treatment failure in methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs) and higher vancomycin minimum inhibitory concentrations (MICs), despite MICs being below the susceptibility breakpoint of 2 µg/mL. Consensus guidelines recommend considering use of alternative agents for infections involving a higher vancomycin MIC, despite few data to support this approach. Methods. This retrospective case-control study evaluated the effectiveness and safety of vancomycin, compared with that of daptomycin, in the treatment of MRSA BSIs with a high vancomycin MIC (ie, > 1 µg/mL). Results. A total of 118 vancomycin-treated subjects were compared with 59 daptomycin-treated subjects. Clinical failure, defined compositely as mortality, microbiologie failure, and/or recurrence of infection, was numerically lower in daptomycin-treated subjects (31% vs 17%; P = .084) and was mainly driven by a lower incidence of mortality in the daptomycin group (20% vs 9%; P = .046). Factors independently associated with clinical failure included acute renal failure (odds ratio [OR], 3.91 [95% confidence interval {CI}, 1.05-14.56]) and vancomycin treatment group (OR, 3.13 [95%, CI, 1.00-9.76]). Right-sided endocarditis was independently associated with clinical success (OR, 0.07 [95% CI, .01-. 83]). A comparison of 60-day mortality between vancomycin-and daptomycin-treated subjects found a higher probability of survival in the daptomycin-treated group (P = .022). Conclusions. The results demonstrated that daptomycin was associated with a better outcome compared with vancomycin for the treatment of BSIs due to MRSA with higher vancomycin MICs. These findings support the recommendations of recent guidelines, which suggest consideration of the switch to alternative agents when the isolate has a high vancomycin MIC or when patients are not improving during receipt of therapy. |
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| AbstractList | Reports have found a link between vancomycin treatment failure in methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs) and higher vancomycin minimum inhibitory concentrations (MICs), despite MICs being below the susceptibility breakpoint of 2 μg/mL. Consensus guidelines recommend considering use of alternative agents for infections involving a higher vancomycin MIC, despite few data to support this approach.
This retrospective case-control study evaluated the effectiveness and safety of vancomycin, compared with that of daptomycin, in the treatment of MRSA BSIs with a high vancomycin MIC (ie, >1 μg/mL).
A total of 118 vancomycin-treated subjects were compared with 59 daptomycin-treated subjects. Clinical failure, defined compositely as mortality, microbiologic failure, and/or recurrence of infection, was numerically lower in daptomycin-treated subjects (31% vs 17%; P = .084) and was mainly driven by a lower incidence of mortality in the daptomycin group (20% vs 9%; P = .046). Factors independently associated with clinical failure included acute renal failure (odds ratio [OR], 3.91 [95% confidence interval {CI}, 1.05-14.56]) and vancomycin treatment group (OR, 3.13 [95%, CI, 1.00-9.76]). Right-sided endocarditis was independently associated with clinical success (OR, 0.07 [95% CI, .01-.83]). A comparison of 60-day mortality between vancomycin- and daptomycin-treated subjects found a higher probability of survival in the daptomycin-treated group (P = .022).
The results demonstrated that daptomycin was associated with a better outcome compared with vancomycin for the treatment of BSIs due to MRSA with higher vancomycin MICs. These findings support the recommendations of recent guidelines, which suggest consideration of the switch to alternative agents when the isolate has a high vancomycin MIC or when patients are not improving during receipt of therapy. Reports have found a link between vancomycin treatment failure in methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs) and higher vancomycin minimum inhibitory concentrations (MICs), despite MICs being below the susceptibility breakpoint of 2 μg/mL. Consensus guidelines recommend considering use of alternative agents for infections involving a higher vancomycin MIC, despite few data to support this approach. This retrospective case-control study evaluated the effectiveness and safety of vancomycin, compared with that of daptomycin, in the treatment of MRSA BSIs with a high vancomycin MIC (ie, >1 μg/mL). A total of 118 vancomycin-treated subjects were compared with 59 daptomycin-treated subjects. Clinical failure, defined compositely as mortality, microbiologic failure, and/or recurrence of infection, was numerically lower in daptomycin-treated subjects (31% vs 17%; P = .084) and was mainly driven by a lower incidence of mortality in the daptomycin group (20% vs 9%; P = .046). Factors independently associated with clinical failure included acute renal failure (odds ratio [OR], 3.91 [95% confidence interval {CI}, 1.05-14.56]) and vancomycin treatment group (OR, 3.13 [95%, CI, 1.00-9.76]). Right-sided endocarditis was independently associated with clinical success (OR, 0.07 [95% CI, .01-.83]). A comparison of 60-day mortality between vancomycin- and daptomycin-treated subjects found a higher probability of survival in the daptomycin-treated group (P = .022). The results demonstrated that daptomycin was associated with a better outcome compared with vancomycin for the treatment of BSIs due to MRSA with higher vancomycin MICs. These findings support the recommendations of recent guidelines, which suggest consideration of the switch to alternative agents when the isolate has a high vancomycin MIC or when patients are not improving during receipt of therapy. Our report shows that daptomycin is associated with a better outcome for treatment of methicillin-resistant Staphylococcus aureus strains with higher vancomycin minimum inhibitory concentrations and that treatment with daptomycin is associated with a higher probability of survival at 60 days. (See the Editorial Commentary by Weston and Boucher, on pages 59-61.) Background. Reports have found a link between vancomycin treatment failure in methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs) and higher vancomycin minimum inhibitory concentrations (MICs), despite MICs being below the susceptibility breakpoint of 2 μg/mL. Consensus guidelines recommend considering use of alternative agents for infections involving a higher vancomycin MIC, despite few data to support this approach. Methods. This retrospective case-control study evaluated the effectiveness and safety of vancomycin, compared with that of daptomycin, in the treatment of MRSA BSIs with a high vancomycin MIC (ie, >1 μg/mL). Results. A total of 118 vancomycin-treated subjects were compared with 59 daptomycin-treated subjects. Clinical failure, defined compositely as mortality, microbiologic failure, and/or recurrence of infection, was numerically lower in daptomycin-treated subjects (31% vs 17%; P = .084) and was mainly driven by a lower incidence of mortality in the daptomycin group (20% vs 9%; P = .046). Factors independently associated with clinical failure included acute renal failure (odds ratio [OR], 3.91 [95% confidence interval {CI}, 1.05-14.56]) and vancomycin treatment group (OR, 3.13 [95%, CI, 1.00-9.76]). Right-sided endocarditis was independently associated with clinical success (OR, 0.07 [95% CI, .01-.83]). A comparison of 60-day mortality between vancomycin- and daptomycin-treated subjects found a higher probability of survival in the daptomycin-treated group (P = .022). Conclusions. The results demonstrated that daptomycin was associated with a better outcome compared with vancomycin for the treatment of BSIs due to MRSA with higher vancomycin MICs. These findings support the recommendations of recent guidelines, which suggest consideration of the switch to alternative agents when the isolate has a high vancomycin MIC or when patients are not improving during receipt of therapy. Reports have found a link between vancomycin treatment failure in methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs) and higher vancomycin minimum inhibitory concentrations (MICs), despite MICs being below the susceptibility breakpoint of 2 μg/mL. Consensus guidelines recommend considering use of alternative agents for infections involving a higher vancomycin MIC, despite few data to support this approach.BACKGROUNDReports have found a link between vancomycin treatment failure in methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs) and higher vancomycin minimum inhibitory concentrations (MICs), despite MICs being below the susceptibility breakpoint of 2 μg/mL. Consensus guidelines recommend considering use of alternative agents for infections involving a higher vancomycin MIC, despite few data to support this approach.This retrospective case-control study evaluated the effectiveness and safety of vancomycin, compared with that of daptomycin, in the treatment of MRSA BSIs with a high vancomycin MIC (ie, >1 μg/mL).METHODSThis retrospective case-control study evaluated the effectiveness and safety of vancomycin, compared with that of daptomycin, in the treatment of MRSA BSIs with a high vancomycin MIC (ie, >1 μg/mL).A total of 118 vancomycin-treated subjects were compared with 59 daptomycin-treated subjects. Clinical failure, defined compositely as mortality, microbiologic failure, and/or recurrence of infection, was numerically lower in daptomycin-treated subjects (31% vs 17%; P = .084) and was mainly driven by a lower incidence of mortality in the daptomycin group (20% vs 9%; P = .046). Factors independently associated with clinical failure included acute renal failure (odds ratio [OR], 3.91 [95% confidence interval {CI}, 1.05-14.56]) and vancomycin treatment group (OR, 3.13 [95%, CI, 1.00-9.76]). Right-sided endocarditis was independently associated with clinical success (OR, 0.07 [95% CI, .01-.83]). A comparison of 60-day mortality between vancomycin- and daptomycin-treated subjects found a higher probability of survival in the daptomycin-treated group (P = .022).RESULTSA total of 118 vancomycin-treated subjects were compared with 59 daptomycin-treated subjects. Clinical failure, defined compositely as mortality, microbiologic failure, and/or recurrence of infection, was numerically lower in daptomycin-treated subjects (31% vs 17%; P = .084) and was mainly driven by a lower incidence of mortality in the daptomycin group (20% vs 9%; P = .046). Factors independently associated with clinical failure included acute renal failure (odds ratio [OR], 3.91 [95% confidence interval {CI}, 1.05-14.56]) and vancomycin treatment group (OR, 3.13 [95%, CI, 1.00-9.76]). Right-sided endocarditis was independently associated with clinical success (OR, 0.07 [95% CI, .01-.83]). A comparison of 60-day mortality between vancomycin- and daptomycin-treated subjects found a higher probability of survival in the daptomycin-treated group (P = .022).The results demonstrated that daptomycin was associated with a better outcome compared with vancomycin for the treatment of BSIs due to MRSA with higher vancomycin MICs. These findings support the recommendations of recent guidelines, which suggest consideration of the switch to alternative agents when the isolate has a high vancomycin MIC or when patients are not improving during receipt of therapy.CONCLUSIONSThe results demonstrated that daptomycin was associated with a better outcome compared with vancomycin for the treatment of BSIs due to MRSA with higher vancomycin MICs. These findings support the recommendations of recent guidelines, which suggest consideration of the switch to alternative agents when the isolate has a high vancomycin MIC or when patients are not improving during receipt of therapy. Background. Reports have found a link between vancomycin treatment failure in methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs) and higher vancomycin minimum inhibitory concentrations (MICs), despite MICs being below the susceptibility breakpoint of 2 µg/mL. Consensus guidelines recommend considering use of alternative agents for infections involving a higher vancomycin MIC, despite few data to support this approach. Methods. This retrospective case-control study evaluated the effectiveness and safety of vancomycin, compared with that of daptomycin, in the treatment of MRSA BSIs with a high vancomycin MIC (ie, > 1 µg/mL). Results. A total of 118 vancomycin-treated subjects were compared with 59 daptomycin-treated subjects. Clinical failure, defined compositely as mortality, microbiologie failure, and/or recurrence of infection, was numerically lower in daptomycin-treated subjects (31% vs 17%; P = .084) and was mainly driven by a lower incidence of mortality in the daptomycin group (20% vs 9%; P = .046). Factors independently associated with clinical failure included acute renal failure (odds ratio [OR], 3.91 [95% confidence interval {CI}, 1.05-14.56]) and vancomycin treatment group (OR, 3.13 [95%, CI, 1.00-9.76]). Right-sided endocarditis was independently associated with clinical success (OR, 0.07 [95% CI, .01-. 83]). A comparison of 60-day mortality between vancomycin-and daptomycin-treated subjects found a higher probability of survival in the daptomycin-treated group (P = .022). Conclusions. The results demonstrated that daptomycin was associated with a better outcome compared with vancomycin for the treatment of BSIs due to MRSA with higher vancomycin MICs. These findings support the recommendations of recent guidelines, which suggest consideration of the switch to alternative agents when the isolate has a high vancomycin MIC or when patients are not improving during receipt of therapy. |
| Author | Haque, Nadia Z. Perri, Mary Beth Moore, Carol L. Zervos, Marcus J. Osaki-Kiyan, Paola Donabedian, Susan |
| Author_xml | – sequence: 1 givenname: Carol L. surname: Moore fullname: Moore, Carol L. – sequence: 2 givenname: Paola surname: Osaki-Kiyan fullname: Osaki-Kiyan, Paola – sequence: 3 givenname: Nadia Z. surname: Haque fullname: Haque, Nadia Z. – sequence: 4 givenname: Mary Beth surname: Perri fullname: Perri, Mary Beth – sequence: 5 givenname: Susan surname: Donabedian fullname: Donabedian, Susan – sequence: 6 givenname: Marcus J. surname: Zervos fullname: Zervos, Marcus J. |
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| ContentType | Journal Article |
| Copyright | Copyright © 2012 Oxford University Press on behalf of the Infectious Diseases Society of America The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com. 2011 2015 INIST-CNRS Copyright University of Chicago, acting through its Press Jan 1, 2012 |
| Copyright_xml | – notice: Copyright © 2012 Oxford University Press on behalf of the Infectious Diseases Society of America – notice: The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com. 2011 – notice: 2015 INIST-CNRS – notice: Copyright University of Chicago, acting through its Press Jan 1, 2012 |
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| Keywords | Peptides Daptomycin Case control study Vancomycin Bacteremia Infection Antibiotic Glycopeptide Polypeptide Minimum inhibitory concentration Bacteriosis Bacteria Micrococcales Micrococcaceae Antibacterial agent Staphylococcal infection Lipopeptide Comparative study Staphylococcus aureus |
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| References | Fowler (8_22466084) 2006; 355 (9_31863716) 2008; 62 (5_34662519) 2009; 53 (17_28364903) 2007; 59 Sader (18_36649321) 2010; 66 (4_31383416) 2008; 52 (19_38685222) 2011; 52 Hsu (6_31722819) 2008; 32 Klevens (13_23708261) 2006; 12 Rybak (15_6515264) 2000; 44 Hidayat (3_22792540) 2006; 166 (23_38280542) 2008; 46 (11_36268486) 1999; 19 Levine (22_13869896) 1986; 8 Cui (16_21628217) 2006; 50 (10_38267621) 2003; 36 Rybak (7_32992438) 2009; 66 (20_31171885) 2008; 46 Sakoulas (2_18213979) 2004; 42 (14_30341427) 2008; 52 Smith (24_10721086) 1999; 340 (1_38280138) 2008; 46 SARAVOLATZ (21_8551856) 1982; 96 22109946 - Clin Infect Dis. 2012 Jan 1;54(1):59-61 22460977 - Clin Infect Dis. 2012 May;54(9):1375-6; author reply 1376-7 |
| References_xml | – volume: 355 start-page: 653 issn: 0028-4793 issue: 7 year: 2006 ident: 8_22466084 publication-title: New England Journal of Medicine doi: 10.1056/NEJMoa053783 – volume: 340 start-page: 493 issn: 0028-4793 issue: 7 year: 1999 ident: 24_10721086 publication-title: New England Journal of Medicine doi: 10.1056/NEJM199902183400701 – volume: 42 start-page: 2398 issn: 0095-1137 issue: 6 year: 2004 ident: 2_18213979 publication-title: Journal of Clinical Microbiology doi: 10.1128/JCM.42.6.2398-2402.2004 – volume: 46 start-page: 193 issn: 1058-4838 issue: 2 year: 2008 ident: 1_38280138 publication-title: Clinical Infectious Diseases doi: 10.1086/524667 – volume: 59 start-page: 1190 issn: 0305-7453 issue: 6 year: 2007 ident: 17_28364903 publication-title: Journal of Antimicrobial Chemotherapy doi: 10.1093/jac/dkm091 – volume: 19 start-page: 257 issn: 1875-9114 year: 1999 ident: 11_36268486 doi: 10.1592/phco.19.4.257.30933 – volume: 50 start-page: 1079 issn: 0066-4804 issue: 3 year: 2006 ident: 16_21628217 publication-title: Antimicrobial Agents and Chemotherapy doi: 10.1128/AAC.50.3.1079-1082.2006 – volume: 52 start-page: 1 issn: 1058-4838 issue: 1 year: 2011 ident: 19_38685222 publication-title: Clinical Infectious Diseases doi: 10.1093/cid/ciq015 – volume: 8 start-page: 374 issn: 0162-0886 issue: 3 year: 1986 ident: 22_13869896 publication-title: Reviews of infectious diseases doi: 10.1093/clinids/8.3.374 – volume: 66 start-page: 82 issn: 1079-2082 issue: 1 year: 2009 ident: 7_32992438 publication-title: American Journal of Health-System Pharmacy doi: 10.2146/ajhp080434 – volume: 46 start-page: 2345 issn: 0095-1137 issue: 7 year: 2008 ident: 20_31171885 publication-title: Journal of Clinical Microbiology doi: 10.1128/JCM.00154-08 – volume: 96 start-page: 11 issn: 0003-4819 issue: 1 year: 1982 ident: 21_8551856 publication-title: Annals of Internal Medicine doi: 10.1059/0003-4819-96-1-11 – volume: 46 start-page: 668 issn: 1058-4838 issue: 5 year: 2008 ident: 23_38280542 publication-title: Clinical Infectious Diseases doi: 10.1086/527392 – volume: 32 start-page: 378 issn: 0924-8579 issue: 5 year: 2008 ident: 6_31722819 publication-title: International journal of antimicrobial agents doi: 10.1016/j.ijantimicag.2008.05.007 – volume: 12 start-page: 1991 issn: 1080-6040 issue: 12 year: 2006 ident: 13_23708261 publication-title: Emerging infectious diseases doi: 10.3201/eid1212.060505 – volume: 52 start-page: 1330 issn: 0066-4804 issue: 4 year: 2008 ident: 14_30341427 publication-title: Antimicrobial Agents and Chemotherapy doi: 10.1128/AAC.01602-07 – volume: 44 start-page: 1062 issn: 0066-4804 issue: 4 year: 2000 ident: 15_6515264 publication-title: Antimicrobial Agents and Chemotherapy doi: 10.1128/AAC.44.4.1062-1066.2000 – volume: 52 start-page: 3315 issn: 0066-4804 issue: 9 year: 2008 ident: 4_31383416 publication-title: Antimicrobial Agents and Chemotherapy doi: 10.1128/AAC.00113-08 – volume: 66 start-page: 329 issn: 0732-8893 issue: 3 year: 2010 ident: 18_36649321 publication-title: Diagnostic microbiology and infectious disease doi: 10.1016/j.diagmicrobio.2009.09.017 – volume: 166 start-page: 2138 issn: 0003-9926 issue: 19 year: 2006 ident: 3_22792540 publication-title: Archives of Internal Medicine doi: 10.1001/archinte.166.19.2138 – volume: 53 start-page: 3162 issn: 0066-4804 issue: 7 year: 2009 ident: 5_34662519 publication-title: Antimicrobial Agents and Chemotherapy doi: 10.1128/AAC.00093-09 – volume: 62 start-page: 1413 issn: 0305-7453 issue: 6 year: 2008 ident: 9_31863716 publication-title: Journal of Antimicrobial Chemotherapy doi: 10.1093/jac/dkn372 – volume: 36 start-page: 1418 issn: 1058-4838 issue: 11 year: 2003 ident: 10_38267621 publication-title: Clinical Infectious Diseases doi: 10.1086/375057 – reference: 22109946 - Clin Infect Dis. 2012 Jan 1;54(1):59-61 – reference: 22460977 - Clin Infect Dis. 2012 May;54(9):1375-6; author reply 1376-7 |
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| Snippet | Background. Reports have found a link between vancomycin treatment failure in methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs)... Our report shows that daptomycin is associated with a better outcome for treatment of methicillin-resistant Staphylococcus aureus strains with higher... Reports have found a link between vancomycin treatment failure in methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs) and higher... |
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| SubjectTerms | Adult Aged Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - adverse effects Anti-Bacterial Agents - pharmacology Antibacterial agents Antibiotics Antibiotics. Antiinfectious agents. Antiparasitic agents ARTICLES AND COMMENTARIES Bacteremia Bacteremia - drug therapy Bacteremia - microbiology Bacterial diseases Bacterial infections Bacterial sepsis Biological and medical sciences Blood Case-Control Studies Comparative analysis Daptomycin - administration & dosage Daptomycin - adverse effects Daptomycin - pharmacology Drug resistance Drug therapy Endocarditis Female Health outcomes Human bacterial diseases Humans Infections Infectious diseases Male Medical sciences Methicillin resistant staphylococcus aureus Methicillin-Resistant Staphylococcus aureus - isolation & purification Microbial Sensitivity Tests Middle Aged Mortality Pharmacology. Drug treatments Retrospective Studies Staphylococcal Infections - drug therapy Staphylococcal Infections - microbiology Staphylococcal infections, streptococcal infections, pneumococcal infections Staphylococcus aureus Staphylococcus infections Treatment Outcome Vancomycin - administration & dosage Vancomycin - adverse effects Vancomycin - pharmacology |
| Title | Daptomycin Versus Vancomycin for Bloodstream Infections Due to Methicillin-Resistant Staphylococcus aureus With a High Vancomycin Minimum Inhibitory Concentration: A Case-Control Study |
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