TABLE 2.
Published studies containing clinical details of hVISA-infected patients
| Study (reference no.) | Publication description | No. (%) of hVISA isolates detecteda | No. (%) of therapeutic failures, hVISA: VSSA | Therapeutic failure definition used in study | No. (%) of infections with 30-day mortality, hVISA: VSSA | Other clinical finding(s) |
|---|---|---|---|---|---|---|
| Ariza et al., 1999 (2) | MRSA orthopedic device infections (n = 19); retrospective | 14 (74) | 12 (86): 1 (20) (P not stated) | Persistence or reappearance of infection after 6 weeks of therapy | No data | All patients cured following device removal |
| Kim et al., 2002 (33) | Consecutive S. aureus isolates from any site (n = 3,363); retrospective | 24 (0.7) | 0: 0 | Not stated | 3 (14): 0 | 15 colonized patients, 7 infected patients |
| Bert et al., 2003 (5) | Consecutive MRSA isolates from any site (n = 48); retrospective | 13 (27) | 1 (10): 0 | Persistent bacteremia of >5 days | 1 (7): 6 (17) (P = NSb) | 3 colonized, 10 infected liver transplant patients |
| Charles et al., 2004 (8) | MRSA bacteremic patients (n = 53); retrospective | 5 (9) | 5 (100): 1 (2.1%) (P < 0.01) | Persistent bacteremia and fever for >7 days | 1 (20): 17 (35) (P = 0.7) | hVISA associated with high-bacterial-load infections (P = 0.001) and initial low VANf levels (P = 0.006) |
| Howden et al., 2004 (28) | hVISA confirmed bacteremic patients (n = 25); retrospective | 25 (100) | 19 (76): 0 | Persistent bacteremia or positive sterile-site culture (>7 days and 21 days of therapy, respectively) | 7 (33): 0 | |
| Khosrovaneh et al., 2004 (31) | Persistent and recurrent MRSA bacteremic patients (n = 21); retrospective | 3 (13) | Not stated | No data | Paired isolates tested with no hVISA phenotype detected in the initial blood isolate | |
| Maor et al., 2007 (38) | hVISA confirmed bacteremic patients (n = 264); retrospective | 16 (6) | 7 (44): 0 | Persistent bacteremia of >7 days | 12 (75): 0 | |
| Neoh et al., 2007 (42) | Adequately treated (VAN for >5 days with trough levels of >10 μg/ml) MRSA bacteremic patients (n = 20); retrospective | 2 (10) | 2 (100): 5 (27) (P < 0.01) | Persistence or worsening of symptoms and infection-related mortality | 2 (100): 8 (44) | hVISA associated with greater no. of febrile days (P < 0.01) and increased no. of days for CRPg to decrease by >30% of maximum value (P < 0.01) |
| Fong et al., 2009 (16) | Persistent MRSA infection (>7 days of culture positivity) (n = 56)c; retrospective | 3 (5) | 56 days for hVISA/VISA vs 46 days for VSSA (P < 0.01); 9/9 (100): 21/26 (80) bacteremic patientsd | Duration of bacteremia (in days); persistent bacteremia for >7 daysd | 5 (50): 19 (63) (P = 0.48) | hVISA/VISA associated with bone/joint (P < 0.01) and prosthesis (P = 0.04) infections and increased length of hospital stay (P < 0.01) |
| Maor et al., 2009 (37) | MRSA bacteremic patients (n = 250); retrospective | 27 (12) | 12 days for hVISA vs 2 days for VSSA (P < 0.01) | Duration of bacteremia (in days) | 14 (51): 103 (46) (P = 0.6) | hVISA associated with infective endocarditis (P = 0.007) and osteomyelitis (P = 0.006) |
| Horne et al., 2009 (24) | Consecutive clinical MRSA isolates (n = 117); prospective | 59 (50) | 10 (38): 11 (26) (P = 0.08) | Unresolved signs or symptoms of infection following standard therapy or recurrence of infection within 1 mo of cessation of therapy | 12 (21): 11 (20) (P = 0.93) | hVISA associated with lower rate of infection (P < 0.003) and bacteremia (P < 0.001) |
| Bae et al., 2009 (4) | MRSA infective endocarditis cases from the ICEe cohort (n = 65); prospective | 19 (29) | 13 (68): 17 (37) (P = 0.029) | Persistent bacteremia of >3 days despite active antibiotic treatment | 8 (42): 16 (35) (P = 0.59) | hVISA associated with congestive cardiac failure (P = 0.033) and older patients (P = 0.037) |
| Musta et al., 2009 (41) | MRSA bacteremic patients (n = 489); retrospective | 71 (17) | 20 (47): 101 (42) (P = 0.5) | Persistent bacteremia of >7 days and/or a metastatic infection | 14 (43): 43 (27) (P = 0.5) |
a
For details of detection methods, see Table 1.
b
NS, not significant.
c
Of the 56 patients who met the case definition, 10 cases (3 of hVISA infection and 7 of VISA infection) and 30 randomly assigned controls were selected.
d
Data obtained by personal communication.
e
ICE, International Collaboration on Endocarditis.
f
VAN, vancomycin.
g
CRP, C-reactive protein.