A survey of attitudes towards methicillin-resistant Staphylococcus aureus bacteraemias amongst United Kingdom microbiologists.
OBJECTIVE
Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) in the UK are common and associated with significant morbidity and mortality. Vancomycin is the usual first-line therapy. However, vancomycin treatment of BSIs due to MRSA strains with vancomycin MICs of 1-2 mg/L is successful in <10% of cases. No consensus exists on when to use newer agents, particularly when vancomycin MICs are >1 mg/L. We therefore surveyed UK practices of the management of MRSA BSIs due to isolates with increased vancomycin MICs.


METHODS
Five hundred and seventy-one UK consultant microbiologists were contacted via e-mail and asked to take part in an online survey, hosted at www.surveymonkey.com. Responses were collated by the website, downloaded and analysed in a Microsoft Excel (Microsoft Corporation) spreadsheet.


RESULTS
One hundred and eight respondents participated in the survey. Only 32.7% routinely measure MICs, mostly by Etest. Forty-two percent use vancomycin alone for removable-focus infections, whilst for infections of cardiac or orthopaedic origin, 49% would add rifampicin. Few respondents use daptomycin, linezolid or tigecycline empirically. Sixty-nine percent would use linezolid as a second-line agent, with only 19% opting for daptomycin. For an isolate with a vancomycin MIC of 4 mg/L, respondents would use daptomycin (81%) or linezolid (91%) in patients with a poor clinical response.


CONCLUSIONS
Vancomycin is the mainstay therapy for MRSA BSIs, even when MICs are not measured or raised, despite evidence of high failure rates. The use of newer agents frequently does not follow European or US licensed indications, may be inappropriate and may result in avoidable deaths.
Hussain
A
A
Department of Clinical Microbiology, Sandringham Building, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW, UK. abid.m.hussain@uhl-tr.nhs.uk
Alleyne
S
S
Jenkins
D
D
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D003625:Data Collection / Q000379:methods; D006302:Health Services Research; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D006113:United Kingdom; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use*; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D014640:Vancomycin