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Volume 22, Number 6—June 2016
Research

High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

Rafael San-JuanComments to Author , Esther Viedma, Fernando Chaves, Antonio Lalueza, Jesús Fortún, Elena Loza, Miquel Pujol, Carmen Ardanuy, Isabel Morales, Marina de Cueto, Elena Resino-Foz, Alejandra Morales-Cartagena, Alicia Rico, María P. Romero, María Ángeles Orellana, Francisco López-Medrano, Mario Fernández-Ruiz, and José María Aguado
Author affiliations: University Hospital–Research Institute 12 de Octubre, Madrid, Spain (R. San-Juan, E. Viedma, F. Chaves, A. Lalueza, E. Resino-Foz, A. Morales-Cartagena, M.Á. Orellana, F. López-Medrano, M. Fernández-Ruiz, J. María Aguado); Hospital Universitario Ramón y Cajal, Madrid (J. Fortún, E. Loza); University Hospital–Bellvitge Institute for Biomedical Research, Barcelona, Spain (M. Pujol, C. Ardanuy); Hospital Universitario Virgen de la Macarena, Seville, Spain (I. Morales, M. de Cueto); Hospital Universitario La Paz, Madrid (A. Rico, M.P. Romero)

Main Article

Table 3

Demographic and clinical characteristics of patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection by MICs for vancomycin and daptomycin measured by E-test*

Variable Vancomycin MIC, μg/mL
 Daptomycin MIC, μg/mL
<1.5, n = 40 >1.5, n = 43 p value <0.5, n = 70 >0.5, n = 13 p value
Age, y 61.9 ± 16.0 59.9 ± 19.0 0.42 60.2 ± 17.3 63.8 ± 21.0 0.5
Male sex
 23 (57.5)
 26 (60.5)
 0.42
41 (58.6)
 8 (61.5)
 0.4
Prognosis of underlying disease
Not fatal 18 (45.0) 13 (30.2) 0.3 24 (34.3) 7 (53.8) 0.3
Fatal 17(42.5) 27 (62.8) 0.1 39 (55.7) 5 (38.5) 0.4
Rapidly fatal
 5 (12.5)
 3 (6.9)
 0.6
7 (10.0)
 1 (7.7)
 0.8
Charlson comorbidity index
 3.5 ± 2.6
 4.0 ± 2.1
 0.31
3.7 ± 2.3
 3.5 ± 2.1
 0.9
Previous conditions
Diabetes 20 (50.0) 12 (27.9) 0.06 28 (40) 4 (30.8) 0.6
Malignancy 17 (42.5) 28 (65.1) 0.12 37 (52.9) 8 (61.5) 0.5
Valvular prosthesis 0 (0.0) 1 (2.3) 0.9 1 (1.4) 0 (0.0) 0.9
Ostheoarticular prosthesis 1 (2.5) 2 (4.7) 0.79 2 (2.9) 1 (7.7) 0.6
Renal failure requiring hemodialysis
 7 (17.5)
 3 (6.9)
 0.2
9 (12.9)
 1 (7.7)
 0.5
Type of intravascular catheter
Peripheral venous 17 (42.5) 15 (34.9) 0.71 28 (40) 4 (30.8) 0.7
Nontunneled (temporary) central venous 13 (32.5) 12 (27.9) 0.82 19 (27.1) 6 (46.2) 0.3
Peripherally inserted central 5 (12.5) 5 (11.6) 0.76 10 (14.3) 0 (0.0) 0.3
Permanent central venous
 5 (12.5)
 11 (25.6)
 0.2
13 (18.6)
 3 (23.1)
 0.6
Pitt score at bacteremia onset 1.5 ± 1.7 1.1 ± 1.4 0.9 1.3 ± 1.7 1.2 ± 1.0 0.9
Severe sepsis or septic shock
 11 (27.5)
 6 (13.9)
 0.2
11 (15.7)
 6 (46.2)
 0.02
Empiric treatment including†
Glycopeptides 16 (40.0) 16 (37.2) 0.7 27 (38.5) 5 (38.4) 0.7
Antistaphylococcal β-lactams‡ 21 (52.5) 22 (51.1) 0.9 37 (52.8) 6 (46.1) 0.7
Other antistaphylococcal antimicrobial drugs 1 (2.5) 3 (6.9) 0.7 4 (5.7) 0 (0.0) 0.8
Daptomycin 7 (17.5) 10 (23.2) 0.8 13 (18.5) 4 (30.7) 0.5
None or noneffective antimicrobial drugs
 7 (17.5)
 5 (11.6)
 0.8
10 (14.3)
 2 (15.4)
 0.8
Antimicrobial regimen
Glycopeptides followed by antistaphylococcal 
β-lactam 11 (27.5) 14 (32.6) 0.7 21 (30.0) 4 (30.8) 0.9
Only antistaphylococcal β-lactams 14 (35) 16 (37.2) 0.8 26 (37.1) 4 (30.8) 0.8
Daptomycin followed by antistaphylococcal β-lactam 3 (7.5) 9 (20.9) 0.16 8 (11.4) 4 (30.8) 0.2
Only daptomycin 1 (2.5) 0 (0.0) 0.9 1 (1.5) 0 (0.0) 0.9
Glycopeptides followed by daptomycin plus 
antistaphylococcal β-lactam 6 (15.0) 1 (2.3) 0.09 6 (8.6) 1 (7.7) 0.9
Daptomycin plus antistaphylococcal β-lactam 4 (10.0) 3 (6.9) 0.8 7 (10) 0 (0.0) 0.5
Other
 1 (1.25)
 0 (0.0)
 0.6
1 (2.5)
 0 (0.0)
 0.7
Timing of catheter removal
Same day or before sampling first blood cultures 28 (70.0) 19 (44.2) 0.03 41 (58.6) 6 (46.2) 0.7
1 day after sampling 6 (15.0) 6 (13.9) 0.9 10 (14.3) 2 (15.4) 0.9
2 days after sampling 5 (12.5) 12 (27.9) 0.1 12 (17.1) 5 (38.5) 0.2
3 days after sampling
 1 (2.5)
 6 (13.9)
 0.1
7 (10.0)
 0 (0.0)
 0.6
Complicated MSSA CRBSI 8 (20.0) 18 (41.9) 0.05 17 (24.3) 9 (69.2) 0.004
Persistent fever for >4 d 3 (7.5) 8 (18.6) 0.2 9 (12.9) 2 (15.4) 0.8
Persistent bacteremia for >72 h 2 (5.0) 4 (9.3) 0.7 5 (7.1) 1 (7.7) 0.9
Septic thrombophlebitis 1 (2.5) 9 (20.9) 0.02 4 (5.7) 6 (46.2) <0.0001
Endocarditis 1 (2.5) 1 (2.3) 0.9 2 (2.9) 0 (0.0) 0.9
Hematogenous osteoarticular infection 1 (2.5) 1 (2.3) 0.9 1 (1.4) 1 (7.7) 0.5
Pulmonary emboli
 2 (4.7)
 0 (0.0)
 0.3
2 (2.9)
 0 (0.0)
 0.6
All-cause deaths at 30 days 6 (15.0) 4 (9.3) 0.5 9 (12.9) 1 (7.7) 0.5
MSSA CRBSI–attributable deaths at 30 days 1 (2.5) 1 (2.3) 0.4 2 (2.9) 0 (0.0) 0.4

*Values are geometric mean ± SD or no. (%). MSSA CRBSI: methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection.
†Some patients could be included in >1 category.
‡Parenteral cloxacillin, cefazolin, amoxicillin/clavulanate, piperacillin/tazobactam, imipenem, or meropenem.

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Page created: May 16, 2016
Page updated: May 16, 2016
Page reviewed: May 16, 2016
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