title: Relationship of teicoplanin MICs to treatment failure in teicoplanin-treated patients with methicillin-resistant Staphylococcus aureus pneumonia.
abstract: OBJECTIVE
  The objective of this study was to determine the predictive value of teicoplanin minimal inhibitory concentrations (MICs) for treatment failure among patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.
  
  
  METHODS
  In this study, all patients with ≥1 tracheal aspirates or sputum cultures positive for MRSA admitted to the hospital between April 2011 and September 2011 were reviewed. We enrolled patients who are ≥18 years of age, with a diagnosis of pneumonia, and with a receipt of teicoplanin therapy throughout the course. The relationship between teicoplanin Etest MICs and treatment outcomes of MRSA pneumonia was analyzed to identify the breakpoint of teicoplanin MICs influencing treatment outcomes.
  
  
  RESULTS
  Of the 80 patients enrolled, 31 had a lower teicoplanin MIC level (<2.0 mg/L) and 49 had a higher MIC level (≥2.0 mg/L) for MRSA. The lower MIC group had a higher clinical resolution rate in 14 days [24 (77.4%) vs. 23 (46.9%), p = 0.007] and a lower treatment failure rate at the end of teicoplanin treatment [4 (12.9%) vs. 18 (36.7%), p = 0.020]. A comparison between the treatment success and failure groups showed that the former had a longer duration of teicoplanin use (18.76 ± 10.34vs.12.41 ± 5.65 days; p = 0.014). Results of a multivariate analysis showed that teicoplanin MICs ≥ 2.0 mg/Land shorter duration of teicoplanin therapy were independent risk factors for treatment failure.
  
  
  CONCLUSIONS
  A higher teicoplanin MIC value (≥2.0 mg/L) may predict the treatment failure among patients with teicoplanin-treated MRSA pneumonia.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ke-Yuan
authors.initials: KY
authors.lastname: Chen
authors.forename: Hong-Jyun
authors.initials: HJ
authors.lastname: Chang
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Hsu
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Yang
authors.forename: Ju-Hsin
authors.initials: JH
authors.lastname: Chia
authors.forename: Tsu-Lan
authors.initials: TL
authors.lastname: Wu
authors.forename: Ching-Tai
authors.initials: CT
authors.lastname: Huang
authors.forename: Ming-Hsun
authors.initials: MH
authors.lastname: Lee
mesh_terms: D024881:Drug Resistance, Bacterial; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy*; D011379:Prognosis; D013183:Sputum / Q000382:microbiology; D017334:Teicoplanin / Q000494:pharmacology / Q000627:therapeutic use*; D014132:Trachea / Q000382:microbiology; D017211:Treatment Failure
chemical_list: D017334:Teicoplanin