title: Ventilator-associated pneumonia by methicillin-susceptible Staphylococcus aureus: do minimum inhibitory concentrations to vancomycin and daptomycin matter?
abstract: The use of vancomycin minimum inhibitory concentration (MIC) as an outcome predictor in patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia has become an important topic for debate in the last few years. Given these previous results, we decided to investigate whether MICs to vancomycin or daptomycin had any effect on the evolution of patients with ventilator-associated pneumonia (VAP) due to MSSA. An observational, retrospective, multicenter study was conducted among patients with MSSA VAP. We analyzed the relationship between vancomycin and daptomycin MICs and early clinical response (72 h), 30-day mortality, intensive care unit (ICU) length of stay (LOS), and duration on mechanical ventilation. Univariate and multivariate analyses were performed. Sixty-six patients from 12 centers were included. Twenty-six patients (39%) had an infection due to MSSA strains with a vancomycin MIC ≥1.5 μg/mL. Daptomycin MIC was determined in 58 patients, of whom 17 (29%) had an MIC ≥1.0 μg/mL. Ten patients (15%) did not respond to first-line treatment. Only daptomycin MIC ≥1.0 μg/mL had a significant association [odds ratio (OR): 30.00; 95% confidence interval (CI): 2.91-60.41] with early treatment failure. The 30-day mortality was 12% (n = 8). Any variable was associated with mortality in the multivariate analysis. None of the variables studied were associated with ICU LOS or duration on mechanical ventilation. In patients with MSSA VAP, vancomycin MIC does not influence the response to antibiotic treatment or the 30-day mortality. Daptomycin MIC was directly related to early treatment failure.
authors.affiliation: Intensive Care Unit, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ruiz-Ramos
authors.affiliation: Intensive Care Unit, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Vidal-Cortés
authors.affiliation: Intensive Care Unit, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Díaz-Lamas
authors.affiliation: Intensive Care Unit, Hospital Universitario General de Castellón, Castellón, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Reig-Valero
authors.affiliation: Intensive Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Roche-Campo
authors.affiliation: Intensive Care Unit, Hospital Universitario de Burgos, Burgos, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Del Valle-Ortiz
authors.affiliation: Intensive Care Unit, Hospital Universitari Arnau de Vilanova, Lleida, Spain.|Institut de Recerca Biomèdica (IRB Lleida), Lleida, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Nuvials-Casals
authors.affiliation: Intensive Care Unit, Hospital Lucus Augusti, Lugo, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Ortiz-Piquer
authors.affiliation: Intensive Care Unit, Hospital Clínico Universitario Valladolid, Valladolid, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Andaluz-Ojeda
authors.affiliation: Intensive Care Unit, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Tamayo-Lomas
authors.affiliation: Intensive Care Unit, Hospital Universitario Severo Ochoa, Leganés, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Blasco-Navalpotro
authors.affiliation: Intensive Care Unit, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Rodriguez-Aguirregabiria
authors.affiliation: Infectious Disease Department, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Aguado
authors.affiliation: Intensive Care Unit, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell n°106, 46026, Valencia, Spain. ramirez_pau@gva.es.
authors.forename: P
authors.initials: P
authors.lastname: Ramirez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D015897:Comorbidity; D017576:Daptomycin / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D016896:Treatment Outcome; D014640:Vancomycin / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D014640:Vancomycin; D017576:Daptomycin
keywords: Daptomycin; Early Treatment Failure; Minimum Inhibitory Concentration; Vancomycin; Vancomycin Minimum Inhibitory Concentration