title: Treatment outcomes for serious infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility.
abstract: 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.
authors.affiliation: Department of Infectious Diseases, Austin Hospital, Heidelberg, Victoria, Australia. Benjamin.Howden@austin.org.au
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Howden
authors.forename: Peter B
authors.initials: PB
authors.lastname: Ward
authors.forename: Patrick G P
authors.initials: PG
authors.lastname: Charles
authors.forename: Tony M
authors.initials: TM
authors.lastname: Korman
authors.forename: Andrew
authors.initials: A
authors.lastname: Fuller
authors.forename: Philipp
authors.initials: P
authors.lastname: du Cros
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Grabsch
authors.forename: Sally A
authors.initials: SA
authors.lastname: Roberts
authors.forename: Jenny
authors.initials: J
authors.lastname: Robson
authors.forename: Kerry
authors.initials: K
authors.lastname: Read
authors.forename: Narin
authors.initials: N
authors.lastname: Bak
authors.forename: James
authors.initials: J
authors.lastname: Hurley
authors.forename: Paul D R
authors.initials: PD
authors.lastname: Johnson
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Morris
authors.forename: Barrie C
authors.initials: BC
authors.lastname: Mayall
authors.forename: M Lindsay
authors.initials: ML
authors.lastname: Grayson
mesh_terms: D000081:Acetamides / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000069349:Linezolid; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D023303:Oxazolidinones / Q000627:therapeutic use*; D012293:Rifampin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects*; D016896:Treatment Outcome; D014640:Vancomycin; D020713:Vancomycin Resistance
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid; D012293:Rifampin