TABLE 1.
Characteristics and outcomes of USA600 MRSA BSIsa
| Patient no. | Patient age (yr), sex | Source of BSI | APACHE II score | Treatment(s) (day[s])b | DOB (days) | V MIC (μg/ml) for infecting strain by Etest | V MIC (μg/ml) for infecting strain by BMD | V MBC (μg/ml) for infecting strain | Infecting strain identified as V tolerant | Infecting strain identified as hVISA by: |
Outcome for patient/comments | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MET | POP | |||||||||||
| 1 | 56, M | Pneumonia | 16 | V (3-18) | 1 | 2 | 0.5 | 0.5 | No | Yes | Yes | Died (day 45) |
| 2 | 60, F | Endocarditis | 24 | V (1-11) | 5 | 2 | 1 | 2 | No | Yes | Yes | Died (day 11) |
| 3 | 86, M | Pneumonia | 22 | V+T (1-6), V (6-8) | 1 | 1.5 | 0.5 | ≥32 | Yes | No | NT | Died (day 8) |
| 4 | 75, F | Infected graft | 20 | V+G (1-6), V (6-42) | 4 | 1.5 | 0.5 | ≥32 | Yes | Yes | No | Had graft removed on day 6; died (day 100) |
| 5 | 41, F | Unknown | NA | NA (patient was dead on arrival at emergency room) | NA | 1.5 | 0.5 | 16 | Yes | Yes | No | Died (day 1) |
| 6 | 89, F | Genitourinary system | 32 | V (2-3) | 1 | 2 | 0.5 | ≥32 | Yes | Yes | No | Withdrew from care; died (day 8) |
| 7 | 83, F | Pneumonia | 38 | V+T (1), C (1-2) | 1 | 1.5 | 0.5 | ≥32 | Yes | No | NT | Died (day 2) |
| 8 | 77, F | Skin/wound | 18 | V (1-6) | 1 | 2 | 0.5 | 0.5 | No | No | NT | Died (day 6) |
| 9 | 54, M | Endocarditis | 23 | V (1-10) | 13 | 2 | 0.5 | ≥32 | Yes | Yes | No | Experienced microbiologic failure; died (day 13) |
| 10 | 44, F | Catheter | 20 | L+G (1-5), D (5-7), V (7-38) | 1 | 1.5 | 0.5 | 0.5 | No | No | NT | Treated successfully |
| 11 | 98, F | Genitourinary system | 14 | L (1-3), V (3-38) | 25 | 1.5 | 0.5 | 0.5 | No | No | NT | Experienced microbiologic failure; died (day 62) |
| 12 | 55, F | Skin/wound | 14 | V (2-15), TS (4-7) | 11 | 1.5 | 0.5 | ≥32 | Yes | Yes | Yes | Experienced microbiologic failure |
| 13 | 65, M | Osteomyelitis | 19 | V (1-4), D (4-22), R (8-26), G (10-14), V (26-29), L (29-70) | 18 | 1.5 | 0.5 | ≥32 | Yes | No | NT | Experienced microbiologic failure |
| 14 | 62, M | Infected pacemaker | 13 | D (1-8), R (1-4), TS (4-8) | 7 | 3 | 2 | 2 | No | Yes | Yes | Had pacemaker removed on day 7; died (day 9) |
| 15 | 38, F | LVAD | 12 | V (1-10), D (10-13), R (8-13), G (8-13)c | 258 | 1.5 | 0.5 | 0.5 | No | No | NT | Experienced microbiologic failure; died (day 258) |
| 16 | 34, F | Skin/wound | 12 | V (1-14) | 1 | 1.5 | 0.5 | ≥32 | Yes | No | NT | Treated successfully |
Abbreviations: DOB, duration of bacteremia; POP, population analysis; NA, not applicable; NT, not tested; LVAD, left ventricular assist device; V, vancomycin; T, tobramycin; G, gentamicin; C, clindamycin; L, linezolid; D, daptomycin; TS, TMP-SMX; and R, rifampin.
Of 14 patients treated with vancomycin, 8 did not have serum vancomycin concentrations recorded (5 were on hemodialysis, 2 received treatment for <48 h, and data for 1 were not available). The initial (≤48-h) vancomycin serum troughs of the six remaining patients were 10 to 15 μg/ml (n = 4) and >15 μg/ml (n = 2). The definitive (>48-h) vancomycin serum troughs were 10 to 15 μg/ml (n = 1) and >15 μg/ml (n = 4); data for the remaining patient (n = 1) were not available. Numbers in parentheses are days postpresentation on which treatment was received.
Antibiotics from the first hospitalization are reported in the table. The patient was treated consecutively for 258 days with the following agents: vancomycin, daptomycin, rifampin, TMP-SMX, linezolid, and quinupristin-dalfopristin.