Treatment Outcomes for Serious Infections Caused by Methicillin-Resistant Staphylococcus aureus with Reduced Vancomycin Susceptibility

• Published in: Clinical infectious diseases Vol. 38; no. 4; pp. 521 - 528
• Main Authors: Howden, Benjamin P., Ward, Peter B., Charles, Patrick G. P., Korman, Tony M., Fuller, Andrew, du Cros, Philipp, Grabsch, Elizabeth A., Roberts, Sally A., Robson, Jenny, Read, Kerry, Bak, Narin, Hurley, James, Johnson, Paul D. R., Morris, Arthur J., Mayall, Barrie C., Grayson, M. Lindsay
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.02.2004; University of Chicago Press
• Subjects: Acetamides - therapeutic use; Aged; Aged, 80 and over; Anti-Infective Agents - therapeutic use; Antibiotics; Arthritis; Bacteremia; Bacterial diseases; Biological and medical sciences; Cardiology. Vascular system; Diabetes mellitus; Endocardial and cardiac valvular diseases; Endocarditis; Female; Glycopeptides; Heart; Human bacterial diseases; Humans; Infections; Infectious diseases; Linezolid; Major Articles; Male; Medical sciences; Methicillin Resistance; Methicillin resistant staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Ovulation method; Oxazolidinones - therapeutic use; Rifampin - therapeutic use; Staphylococcal Infections - drug therapy; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Staphylococcus aureus - drug effects; Treatment Outcome; Vancomycin; Vancomycin Resistance; New Zealand; Australia; Oceania; Linezolid; Prognosis; Peptides; Diseases of the osteoarticular system; Fusidic acid; Cardiovascular disease; Arthritis; Vancomycin; Rifampicin; Glycopeptide; Heart disease; Osteitis; Endocardial disease; Bacteria; Micrococcales; Micrococcaceae; Antituberculous agent; Oxazole derivatives; Staphylococcus aureus; Human; Bacteremia; Infection; Symptomatology; Treatment; Polypeptide; Oxazolidinone derivative; Endocarditis; Bacteriosis; Empyema; Isolation; Staphylococcal infection; Bibliographic review
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/381202

Although infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility (SA-RVS) have been reported from a number of countries, including Australia, the optimal therapy is unknown. We reviewed the clinical features, therapy, and outcome of 25 patients with serious infections due to SA-RVS in Australia and New Zealand. Eight patients had endocarditis, 9 had bacteremia associated with deep-seated infection, 6 had osteomyelitis or septic arthritis, and 2 had empyema. All patients had received vancomycin before the isolation of SA-RVS, and glycopeptide treatment had failed for 19 patients (76%). Twenty-one patients subsequently received active treatment, which was effective for 16 patients (76%). Eighteen patients received linezolid, which was effective in 14 (78%), including 4 patients with endocarditis. Twelve patients received a combination of rifampicin and fusidic acid. Surgical intervention was required for 15 patients (60%). Antibiotic therapy, especially linezolid with or without rifampicin and fusidic acid, in conjunction with surgical debulking is effective therapy for the majority of patients with serious infections (including endocarditis) caused by SA-RVS.