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Volume 17, Number 6—June 2011

Dispatch

High Vancomycin MIC and Complicated Methicillin-Susceptible Staphylococcus aureus Bacteremia

Jose Maria AguadoComments to Author , Rafael San-Juan, Antonio Lalueza, Francisca Sanz, Joaquin Rodríguez-Otero, Carmen Gómez-Gonzalez, and Fernando Chaves
Author affiliations: Author affiliations: University Hospital 12 de Octubre, Madrid, Spain

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Table 2

Comparative analysis of 99 patients with complicated vs. noncomplicated MSSA bacteremia, Hospital 12 de Octubre, Madrid, Spain, January 2002–December 2004*

Variable Noncomplicated MSSA, n = 71 Complicated MSSA, n = 28 p value
Mean age, y (SD) 63.9 (17.4) 62 (16) 0.6
M/F, % 69/31 60.7/39.3 0.8
Co-morbidity Charlson Index, mean (SD)
2.92 (2.4)
2.93 (3.5)
0.9
Previous valvular prosthesis 1 (1.4) 2 (7.1) 0.39
Other previous endovascular prosthesis 4 (5.6) 1 (3.6) 0.9
Previous ostheoarticular prosthesis 2 (2.8) 1 (3.6) 0.8
Previous renal failure requiring hemodyalisis
8 (11.3)
3 (10.7)
0.8
Type of IV catheter as the source of bacteremia
Peripheral line 32 (45.1) 11 (39.3) 0.7
Transitory central catheter 30 (42.2) 14 (50) 0.8
Permanent central catheter
9 (12.7)
3 (10.7)
0.9
Vancomycin MIC for the first MSSA isolate, median (range) 1.2 (0.5–1.7) 1.5 (1.0–1.7) <0.0001
Vancomycin MIC >1.5 µg/mL for the first MSSA isolate
5 (7)
18 (64.3)
<0.0001
Initial treatment with glycopeptides 41 (57.7) 23 (82.1) 0.042
Initial treatment with antistaphylococcal β-lactams† 20 (28.2) 5 (17.9) 0.42
Initial treatment with non–β-lactam antistaphylococcal agents‡ 7 (9.9) 0 0.19
Delay in initiation of active antibiotic treatment, d,§ mean (SD) 0.92 (1.3) 1.07 (1) 0.8
Delay >24 h at the start of effective antibiotics§ 28 (39.4) 14 (53.6) 0.2
Duration of antibiotic treatment, d, mean (SD)
12.77 (8)
19.39 (11.4)
0.002
Prompt IV catheter removal¶ 58 (81.7) 21 (75) 0.65
Conservative IV catheter management#
5 (7)
1 (3.6)
0.8
Development of severe sepsis/septic shock
9 (12.7)
7 (25)
0.23
Days of follow-up, mean (SD) 502 (441) 462 (463) 0.77
Crude 30-day death rate 9 (12.7) 5 (17.9) 0.9
Attributable death rate 3 (4.2) 4 (14.3) 0.18

*Values are no. (%) except as indicated. MSSA, methicillin-susceptible Staphylococcus aureus; IV, intravenous.
†Antistaphylococcal β-lactams refer to parenteral cloxacillin, cefazolin, amoxicillin-clavulanate, piperacillin-tazobactam, or imipenem/meropenem.
‡Including non–β-lactam antibiotics with in vitro activity against MSSA (mostly levofloxacin, moxifloxacin, or clindamycin).
§Delay since isolation of MSSA in blood cultures.
¶Removal of catheter in the first 48 h since isolation of MSSA in blood cultures.
#Catheter kept at least 7 days since isolation of MSSA in blood cultures.

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