title: Derivation and validation of clinical prediction rules for reduced vancomycin susceptibility in Staphylococcus aureus bacteraemia.
abstract: Reduced vancomycin susceptibility (RVS) may lead to poor clinical outcomes in Staphylococcus aureus bacteraemia. We conducted a cohort study of 392 patients with S. aureus bacteraemia within a university health system. The association between RVS, as defined by both Etest [vancomycin minimum inhibitory concentration (MIC) >1·0 μg/ml] and broth microdilution (vancomycin MIC ≥1·0 μg/ml), and patient and clinical variables were evaluated to create separate predictive models for RVS. In total, 134 (34·2%) and 73 (18·6%) patients had S. aureus isolates with RVS by Etest and broth microdilution, respectively. The final model for RVS by Etest included methicillin resistance [odds ratio (OR) 1·51, 95% confidence interval (CI) 0·97-2·34], non-white race (OR 0·67, 95% CI 0·42-1·07), healthcare-associated infection (OR 0·56, 95% CI 0·32-0·96), and receipt of any antimicrobial therapy ≤30 days prior to the culture date (OR 3·06, 95% CI 1·72-5·44). The final model for RVS by broth microdilution included methicillin resistance (OR 2·45, 95% CI 1·42-4·24), admission through the emergency department (OR 0·54, 95% CI 0·32-0·92), presence of an intravascular device (OR 2·24, 95% CI 1·30-3·86), and malignancy (OR 0·51, 95% CI 0·26-1·00). The availability of an easy and rapid clinical prediction rule for early identification of RVS can be used to help guide the timely and individualized management of these serious infections.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. jennifer.han@uphs.upenn.edu
authors.forename: J H
authors.initials: JH
authors.lastname: Han
authors.forename: W B
authors.initials: WB
authors.lastname: Bilker
authors.forename: P H
authors.initials: PH
authors.lastname: Edelstein
authors.forename: K B
authors.initials: KB
authors.lastname: Mascitti
authors.forename: E
authors.initials: E
authors.lastname: Lautenbach
mesh_terms: D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D015331:Cohort Studies; D003661:Decision Support Techniques; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D020713:Vancomycin Resistance