title: Impact of Vancomycin MIC on Treatment Outcomes in Invasive Staphylococcus aureus Infections.
abstract: There are conflicting data on the association of vancomycin MIC (VAN-MIC) with treatment outcomes inStaphylococcus aureusinfections. We investigated the relationship between high VAN-MIC and 30-day mortality and identified the risk factors for mortality in a large cohort of patients with invasiveS. aureus(ISA) infections, defined as the isolation ofS. aureusfrom a normally sterile site. Over a 2-year period, 1,027 adult patients with ISA infections were enrolled in 10 hospitals, including 673 (66%) patients with methicillin-resistantS. aureus(MRSA) infections. There were 200 (19.5%) isolates with high VAN-MIC (≥1.5 mg/liter) by Etest and 87 (8.5%) by broth microdilution (BMD). The all-cause 30-day mortality rate was 27.4%. High VAN-MIC by either method was not associated with all-cause 30-day mortality, and this finding was consistent across MIC methodologies and methicillin susceptibilities. We conclude that high VAN-MIC is not associated with increased risk of all-cause 30-day mortality in ISA infections. Our data support the view that VAN-MIC alone is not sufficient evidence to change current clinical practice.
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Kyoung-Ho
authors.initials: KH
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Moonsuk
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Chung Jong
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Yun Jung
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Jeong Su
authors.initials: JS
authors.lastname: Park
authors.affiliation: Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Soyeon
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Hee-Chang
authors.initials: HC
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Sook-In
authors.initials: SI
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Chosun University Hospital, Gwangju, South Korea.
authors.forename: Nara
authors.initials: N
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Chosun University Hospital, Gwangju, South Korea.
authors.forename: Dong-Min
authors.initials: DM
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, South Korea.
authors.forename: Jeong-Hwan
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, South Korea.
authors.forename: Chang Seop
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Wonkwang University Hospital, Iksan, South Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
authors.forename: Yee Gyung
authors.initials: YG
authors.lastname: Kwak
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Eu Suk
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea.
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea.
authors.forename: Yoonseon
authors.initials: Y
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seonam University Myongji Hospital, Goyang, South Korea.
authors.forename: Kkot Sil
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Center for Infectious Diseases, Korea National Institute of Health, Osong, South Korea.
authors.forename: Yeong-Seon
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea hbkimmd@snu.ac.kr.
authors.forename: Hong Bin
authors.identifier: 0000-0001-6262-372X
authors.initials: HB
authors.lastname: Kim
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008712:Methicillin / Q000494:pharmacology; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011934:Reagent Strips; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D014640:Vancomycin / Q000494:pharmacology*; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D011934:Reagent Strips; D014640:Vancomycin; D008712:Methicillin
keywords: MIC; Staphylococcus aureus; bacteremia; methicillin resistant; methicillin susceptible; vancomycin