Influence of vancomycin minimum inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus left-sided infective endocarditis treated with antistaphylococcal β-lactam antibiotics: a prospective cohort study by the International Collaboration on Endocarditis

Juan M. Pericas, J. A. Messina, C. Garcia-de-la-Mària, L. Park, B. K. Sharma-Kuinkel, F. Marco, D. Wray, Z.A. Kanafani, M. Carugati, E. Durante-Mangoni, P. Tattevin, V.H. Chu, A. Moreno, V.G. Fowler Jr, J.M. Miro, the International Collaboration on Endocarditis Microbiology Investigators

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives Left-sided methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis treated with cloxacillin has a poorer prognosis when the vancomycin minimum inhibitory concentration (MIC) is ≥1.5 mg/L. We aimed to validate this using the International Collaboration on Endocarditis cohort and to analyse whether specific genetic characteristics were associated with a high vancomycin MIC (≥1.5 mg/L) phenotype. Methods All patients with left-sided MSSA infective endocarditis treated with antistaphylococcal β-lactam antibiotics between 2000 and 2006 with available isolates were included. Vancomycin MIC was determined by Etest as either high (≥1.5 mg/L) or low (<1.5 mg/L). Isolates underwent spa typing to infer clonal complexes and multiplex PCR for identifying virulence genes. Univariate analysis was performed to evaluate the association between in-hospital and 1-year mortality, and vancomycin MIC phenotype. Results Sixty-two cases met the inclusion criteria. Vancomycin MIC was low in 28 cases (45%) and high in 34 cases (55%). No significant differences in patient demographic data or characteristics of infection were observed between patients with infective endocarditis due to high and low vancomycin MIC isolates. Isolates with high and low vancomycin MIC had similar distributions of virulence genes and clonal lineages. In-hospital and 1-year mortality did not differ significantly between the two groups (32% (9/28) vs. 27% (9/34), p 0.780; and 43% (12/28) vs. 29% (10/34), p 0.298, for low and high vancomycin MIC respectively). Conclusions In this international cohort of patients with left-sided MSSA endocarditis treated with antistaphylococcal β-lactams, vancomycin MIC phenotype was not associated with patient demographics, clinical outcome or virulence gene repertoire.

Original languageEnglish
Pages (from-to)544-549
Number of pages6
JournalClinical Microbiology and Infection
Volume23
Issue number8
DOIs
Publication statusPublished - 1 Aug 2017
Externally publishedYes

Keywords

  • Endocarditis
  • Genotype
  • Phenotype
  • Staphylococcus aureus
  • Vancomycin MIC

Cite this

Pericas, Juan M. ; Messina, J. A. ; Garcia-de-la-Mària, C. ; Park, L. ; Sharma-Kuinkel, B. K. ; Marco, F. ; Wray, D. ; Kanafani, Z.A. ; Carugati, M. ; Durante-Mangoni, E. ; Tattevin, P. ; Chu, V.H. ; Moreno, A. ; Fowler Jr, V.G. ; Miro, J.M. ; the International Collaboration on Endocarditis Microbiology Investigators. / Influence of vancomycin minimum inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus left-sided infective endocarditis treated with antistaphylococcal β-lactam antibiotics : a prospective cohort study by the International Collaboration on Endocarditis. In: Clinical Microbiology and Infection. 2017 ; Vol. 23, No. 8. pp. 544-549.
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title = "Influence of vancomycin minimum inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus left-sided infective endocarditis treated with antistaphylococcal β-lactam antibiotics: a prospective cohort study by the International Collaboration on Endocarditis",
abstract = "Objectives Left-sided methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis treated with cloxacillin has a poorer prognosis when the vancomycin minimum inhibitory concentration (MIC) is ≥1.5 mg/L. We aimed to validate this using the International Collaboration on Endocarditis cohort and to analyse whether specific genetic characteristics were associated with a high vancomycin MIC (≥1.5 mg/L) phenotype. Methods All patients with left-sided MSSA infective endocarditis treated with antistaphylococcal β-lactam antibiotics between 2000 and 2006 with available isolates were included. Vancomycin MIC was determined by Etest as either high (≥1.5 mg/L) or low (<1.5 mg/L). Isolates underwent spa typing to infer clonal complexes and multiplex PCR for identifying virulence genes. Univariate analysis was performed to evaluate the association between in-hospital and 1-year mortality, and vancomycin MIC phenotype. Results Sixty-two cases met the inclusion criteria. Vancomycin MIC was low in 28 cases (45{\%}) and high in 34 cases (55{\%}). No significant differences in patient demographic data or characteristics of infection were observed between patients with infective endocarditis due to high and low vancomycin MIC isolates. Isolates with high and low vancomycin MIC had similar distributions of virulence genes and clonal lineages. In-hospital and 1-year mortality did not differ significantly between the two groups (32{\%} (9/28) vs. 27{\%} (9/34), p 0.780; and 43{\%} (12/28) vs. 29{\%} (10/34), p 0.298, for low and high vancomycin MIC respectively). Conclusions In this international cohort of patients with left-sided MSSA endocarditis treated with antistaphylococcal β-lactams, vancomycin MIC phenotype was not associated with patient demographics, clinical outcome or virulence gene repertoire.",
keywords = "Endocarditis, Genotype, Phenotype, Staphylococcus aureus, Vancomycin MIC",
author = "Pericas, {Juan M.} and Messina, {J. A.} and C. Garcia-de-la-M{\`a}ria and L. Park and Sharma-Kuinkel, {B. K.} and F. Marco and D. Wray and Z.A. Kanafani and M. Carugati and E. Durante-Mangoni and P. Tattevin and V.H. Chu and A. Moreno and {Fowler Jr}, V.G. and J.M. Miro and {the International Collaboration on Endocarditis Microbiology Investigators} and Tony Korman and Despina Kotsanas",
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language = "English",
volume = "23",
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Pericas, JM, Messina, JA, Garcia-de-la-Mària, C, Park, L, Sharma-Kuinkel, BK, Marco, F, Wray, D, Kanafani, ZA, Carugati, M, Durante-Mangoni, E, Tattevin, P, Chu, VH, Moreno, A, Fowler Jr, VG, Miro, JM & the International Collaboration on Endocarditis Microbiology Investigators 2017, 'Influence of vancomycin minimum inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus left-sided infective endocarditis treated with antistaphylococcal β-lactam antibiotics: a prospective cohort study by the International Collaboration on Endocarditis' Clinical Microbiology and Infection, vol. 23, no. 8, pp. 544-549. https://doi.org/10.1016/j.cmi.2017.01.017

Influence of vancomycin minimum inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus left-sided infective endocarditis treated with antistaphylococcal β-lactam antibiotics : a prospective cohort study by the International Collaboration on Endocarditis. / Pericas, Juan M.; Messina, J. A.; Garcia-de-la-Mària, C.; Park, L.; Sharma-Kuinkel, B. K.; Marco, F.; Wray, D.; Kanafani, Z.A.; Carugati, M.; Durante-Mangoni, E.; Tattevin, P.; Chu, V.H.; Moreno, A.; Fowler Jr, V.G.; Miro, J.M.; the International Collaboration on Endocarditis Microbiology Investigators.

In: Clinical Microbiology and Infection, Vol. 23, No. 8, 01.08.2017, p. 544-549.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Influence of vancomycin minimum inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus left-sided infective endocarditis treated with antistaphylococcal β-lactam antibiotics

T2 - a prospective cohort study by the International Collaboration on Endocarditis

AU - Pericas, Juan M.

AU - Messina, J. A.

AU - Garcia-de-la-Mària, C.

AU - Park, L.

AU - Sharma-Kuinkel, B. K.

AU - Marco, F.

AU - Wray, D.

AU - Kanafani, Z.A.

AU - Carugati, M.

AU - Durante-Mangoni, E.

AU - Tattevin, P.

AU - Chu, V.H.

AU - Moreno, A.

AU - Fowler Jr, V.G.

AU - Miro, J.M.

AU - the International Collaboration on Endocarditis Microbiology Investigators

AU - Korman, Tony

AU - Kotsanas, Despina

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Objectives Left-sided methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis treated with cloxacillin has a poorer prognosis when the vancomycin minimum inhibitory concentration (MIC) is ≥1.5 mg/L. We aimed to validate this using the International Collaboration on Endocarditis cohort and to analyse whether specific genetic characteristics were associated with a high vancomycin MIC (≥1.5 mg/L) phenotype. Methods All patients with left-sided MSSA infective endocarditis treated with antistaphylococcal β-lactam antibiotics between 2000 and 2006 with available isolates were included. Vancomycin MIC was determined by Etest as either high (≥1.5 mg/L) or low (<1.5 mg/L). Isolates underwent spa typing to infer clonal complexes and multiplex PCR for identifying virulence genes. Univariate analysis was performed to evaluate the association between in-hospital and 1-year mortality, and vancomycin MIC phenotype. Results Sixty-two cases met the inclusion criteria. Vancomycin MIC was low in 28 cases (45%) and high in 34 cases (55%). No significant differences in patient demographic data or characteristics of infection were observed between patients with infective endocarditis due to high and low vancomycin MIC isolates. Isolates with high and low vancomycin MIC had similar distributions of virulence genes and clonal lineages. In-hospital and 1-year mortality did not differ significantly between the two groups (32% (9/28) vs. 27% (9/34), p 0.780; and 43% (12/28) vs. 29% (10/34), p 0.298, for low and high vancomycin MIC respectively). Conclusions In this international cohort of patients with left-sided MSSA endocarditis treated with antistaphylococcal β-lactams, vancomycin MIC phenotype was not associated with patient demographics, clinical outcome or virulence gene repertoire.

AB - Objectives Left-sided methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis treated with cloxacillin has a poorer prognosis when the vancomycin minimum inhibitory concentration (MIC) is ≥1.5 mg/L. We aimed to validate this using the International Collaboration on Endocarditis cohort and to analyse whether specific genetic characteristics were associated with a high vancomycin MIC (≥1.5 mg/L) phenotype. Methods All patients with left-sided MSSA infective endocarditis treated with antistaphylococcal β-lactam antibiotics between 2000 and 2006 with available isolates were included. Vancomycin MIC was determined by Etest as either high (≥1.5 mg/L) or low (<1.5 mg/L). Isolates underwent spa typing to infer clonal complexes and multiplex PCR for identifying virulence genes. Univariate analysis was performed to evaluate the association between in-hospital and 1-year mortality, and vancomycin MIC phenotype. Results Sixty-two cases met the inclusion criteria. Vancomycin MIC was low in 28 cases (45%) and high in 34 cases (55%). No significant differences in patient demographic data or characteristics of infection were observed between patients with infective endocarditis due to high and low vancomycin MIC isolates. Isolates with high and low vancomycin MIC had similar distributions of virulence genes and clonal lineages. In-hospital and 1-year mortality did not differ significantly between the two groups (32% (9/28) vs. 27% (9/34), p 0.780; and 43% (12/28) vs. 29% (10/34), p 0.298, for low and high vancomycin MIC respectively). Conclusions In this international cohort of patients with left-sided MSSA endocarditis treated with antistaphylococcal β-lactams, vancomycin MIC phenotype was not associated with patient demographics, clinical outcome or virulence gene repertoire.

KW - Endocarditis

KW - Genotype

KW - Phenotype

KW - Staphylococcus aureus

KW - Vancomycin MIC

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U2 - 10.1016/j.cmi.2017.01.017

DO - 10.1016/j.cmi.2017.01.017

M3 - Article

VL - 23

SP - 544

EP - 549

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

SN - 1198-743X

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