Volume 22, Number 6—June 2016
Research
High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus
Rafael San-Juan
, Esther Viedma, Fernando Chaves, Antonio Lalueza, Jesús Fortún, Elena Loza, Miquel Pujol, Carmen Ardanuy, Isabel Morales, Marina de Cueto, Elena Resino-Foz, Alejandra Morales-Cartagena, Alicia Rico, María P. Romero, María Ángeles Orellana, Francisco López-Medrano, Mario Fernández-Ruiz, and José María Aguado
, Esther Viedma, Fernando Chaves, Antonio Lalueza, Jesús Fortún, Elena Loza, Miquel Pujol, Carmen Ardanuy, Isabel Morales, Marina de Cueto, Elena Resino-Foz, Alejandra Morales-Cartagena, Alicia Rico, María P. Romero, María Ángeles Orellana, Francisco López-Medrano, Mario Fernández-Ruiz, and José María Aguado
Table 4
Comparative analysis of patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection with or without complicated bacteremia*
| Variable | Complicated bacteremia |
p value | |
|---|---|---|---|
| No, n = 5 | Yes, n = 26 | ||
| Age, y | 61.4 ± 16.0 | 59.3 ± 21.0 | 0.1 |
| Male sex |
32 (56.1) |
17 (65.4) |
0.5 |
| Recruiting center | |||
| 1 | 15 (26.3) | 17 (65.4) | 0.01 |
| 2 | 14 (24.6) | 5 (19.2) | 0.8 |
| 3 | 2 (3.5) | 0 (0.0) | 1.0 |
| 4 | 11 (19.3) | 1 (3.8) | 0.2 |
| 5 |
15 (26.3) |
3 (11.5) |
0.2 |
| Prognosis of underlying disease | |||
| Not fatal | 24 (42.1) | 7 (26.9) | 0.2 |
| Fatal | 29 (50.9) | 15 (57.7) | 0.6 |
| Rapidly fatal |
4 (7.0) |
4 (15.4) |
0.3 |
| Charlson comorbidity index |
3.6 ± 2.4 |
1.9 ± 1.9 |
0.3 |
| Previous conditions | |||
| Diabetes | 20 (35.1) | 12 (46.2) | 0.3 |
| Malignancy | 29 (50.9) | 16 (61.5) | 0.6 |
| Valvular prosthesis | 1 (1.8) | 0 (0.0) | 1.0 |
| Ostheoarticular prosthesis | 1 (1.8) | 2 (7.7) | 0.2 |
| Renal failure requiring hemodialysis |
7 (12.3) |
3 (11.5) |
1.0 |
| Type of intravascular catheter | |||
| Peripheral venous | 23 (40.4) | 9 (34.6) | 0.8 |
| Nontunneled (temporary) central venous | 17 (29.8) | 8 (30.8) | 1.0 |
| Peripherally inserted central | 7 (12.3) | 3 (11.5) | 1.0 |
| Permanent central venous |
10 (17.5) |
6 (23.1) |
0.6 |
| Pitt score at bacteremia onset | 1.1 ± 1.4 | 1.7 ± 1.9 | 0.1 |
| Severe sepsis or septic shock |
11 (19.3) |
6 (23.1) |
0.3 |
| Empiric treatment including† | |||
| Glycopeptides | 24 (42) | 8 (30.7) | 0.4 |
| Antistaphylococcal β-lactams‡ | 31 (54.3) | 12 (46.1) | 0.6 |
| Other antistaphylococcal antimicrobial drugs | 1 (1.7) | 3 (11.5) | 0.2 |
| Daptomycin | 8 (14) | 9 (34.6) | 0.06 |
| Daptomycin monotherapy | 5 (8.8) | 8 (30.8) | 0.02 |
| None or noneffective antimicrobial drugs |
10 (17.5) |
2 (7.7) |
0.4 |
| Antimicrobial regimen | |||
| Glycopeptides followed by antistaphylococcal β-lactam | 19 (33.3) | 6 (23.1) | 0.4 |
| Only antistaphylococcal β-lactams | 23 (40.4) | 7 (26.9) | 0.3 |
| Daptomycin followed by antistaphylococcal β-lactam | 4 (7.0) | 8 (30.8) | 0.01 |
| Only daptomycin | 1 (1.8) | 0 (0.0) | 1.0 |
| Glycopeptides followed by daptomycin plus antistaphylococcal β-lactam | 6 (10.5) | 1 (3.8) | 0.4 |
| Daptomycin plus antistaphylococcal β-lactam | 3 (5.3) | 4 (15.4) | 0.2 |
| Other |
1 (1.8) |
0 (0.0) |
1.0 |
| Timing of catheter removal | |||
| Same day or before of sampling first blood cultures | 36 (63.2) | 11 (42.3) | 0.1 |
| 1 day after sampling | 6 (10.5) | 6 (23.1) | 0.1 |
| 2 days after sampling | 10 (17.5) | 7 (26.9) | 0.4 |
| 3 days after sampling |
5 (8.8) |
2 (7.7) |
1.0 |
| Venous Doppler ultrasound examination | 21 (36.8) | 20 (76.9) | 0.001 |
| Echocardiogram |
36 (63.2) |
25 (96.2) |
0.01 |
| All-cause deaths at 30 days | 7 (12.3) | 3 (11.5) | 1.0 |
| MSSA CRBSI–attributable deaths at 30 days | 0 (0.0) | 2 (7.7) | 0.09 |
*Values are geometric mean ± SD or no. (%). MSSA CRBSI: methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection.
†Some patients could be included in >1 category.
‡Parenteral cloxacillin, cefazolin, amoxicillin/clavulanate, piperacillin/tazobactam, imipenem, or meropenem.
Page created: May 16, 2016
Page updated: May 16, 2016
Page reviewed: May 16, 2016
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